Elsevier

The Journal of Pediatrics

Volume 137, Issue 5, November 2000, Pages 616-622
The Journal of Pediatrics

Original Articles
Survival and neonatal morbidity at the limits of viability in the mid 1990s: 22 to 25 weeks

Presented in part at the annual meeting of the Society for Pediatric Research, San Francisco, Calif, May 1-5, 1999.
https://doi.org/10.1067/mpd.2000.109143Get rights and content

Abstract

Objective: We determined neonatal survival and morbidity rates based on both fetal (stillborn) and neonatal deaths for infants delivered at 22 to 25 weeks’ gestation. Study design: Two hundred seventy-eight deliveries at 22 to 25 weeks’ completed gestation were analyzed by gestational age groups between January 1993 and December 1997. Logistic regression models were used to identify maternal and neonatal factors associated with survival. Results: The rate of fetal death was 24%; 76% of infants were born alive and 46% survived to discharge. Survival rates including fetal death at 22, 23, 24, and 25 weeks were 1.8%, 34%, 49%, and 76%; and survival rates excluding fetal death were 4.6%, 46%, 59%, and 82%, respectively. Logistic regression analyses showed that higher gestational age (P <.0002), higher birth weight (P <.001), female sex (P <.005), and surfactant (P <.003) were associated with neonatal survival. Cesarean section was associated with decreased survival (P <.006). Conclusion: Hospital neonatal survival rates of infants at the limits of viability are significantly lower with the inclusion of fetal deaths. This information should be considered when providing prognostic advice to families when mothers are in labor at 22 to 25 weeks’ gestation. (J Pediatr 2000;137:616-22)

Section snippets

Methods

This was an Institutional Review Board–approved retrospective study of the outcomes of 278 pregnancies in women who were in labor and delivered between 22 and 25 weeks’ completed gestation at Women and Infants’ Hospital between January 1, 1993, and December 31, 1997. The obstetric estimate of completed gestational age was based on postmenstrual dates and early gestation prenatal sonographic findings. If no prenatal data were available, infants were excluded (4 infants were excluded) because the

Results

Of the 278 pregnancies, 24% ended in fetal death; 76% of infants were born alive and 46% survived to discharge. Fetal deaths decreased with increasing gestational age and ranged from 60% at 22 weeks to 8% at 25 weeks (Table I); 57% and 9% of the infants who died at 22 and 23 weeks, respectively, received no resuscitation.

. Outcomes of pregnancies

Empty CellGestational age
22 wk23 wk24 wk25 wk
Deliveries55567394
Fetal deaths (%)33 (60)*†‡15 (27)†‡12 (16)7 (8)
Live births (%)22 (40)*†‡41 (73)61 (84)87 (92)

Discussion

Our results for infants born in a tertiary care center in the 1990s indicate a survival rate of 34% at 23 weeks’ gestation with a single survivor (1.8%) at 22 weeks’ gestation. Despite initial resuscitation attempted for 7 infants at 22 weeks, only one survived to discharge. Similar results were reported by Hack et al17; they reported one survivor at 22 weeks in each of their 2 study periods: period I (1982-88), non-surfactant era, and period II (1990-92), surfactant and postnatal steroids

Acknowledgements

We thank Michael Msall, MD, Professor of Pediatrics, Brown University Medical School and Director of the Child Development Center at Rhode Island Hospital, for reviewing the manuscript. We also thank Michael Pleviak, MD, instructor of Maternal-Fetal Medicine, Brown University Medical School, for his assistance in providing the guidelines for antenatal management.

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  • Cited by (0)

    Reprint requests: Betty R. Vohr, MD, Women and Infants’ Hospital, 101 Dudley St, Providence, RI 02905.

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