Survival and major neonatal complications in infants born between 22 0/7 and 24 6/7 weeks of gestation (1999-2003)
ABSTRACT This study was undertaken to compare survival and morbidity until discharge in infants born after 22-23 versus 24 weeks' gestational age (GA).
Cohort study of all infants 25 weeks or less, born in 3 tertiary perinatal centers (1999-2003).
Of a total of 336 infants, 133 (40%) died before or immediately after birth without the provision of life support, 203 (60%) received active neonatal treatment. Infants with life support (n = 82 at 22 to 23 weeks, n = 121 at 24 weeks) differed with respect to antenatal steroid prophylaxis (44% vs 62%) and cesarean section rate (51% vs 71%). Survival was 67% compared with 82% (P = .016). The incidence of intraventricular hemorrhage III or greater or periventricular leukomalacia (15/15%), severe retinopathy of prematurity (18/15%), and chronic lung disease (40/47%) was similar in both GA groups.
The provision of life support for extremely preterm infants increases their chance of survival without more neonatal morbidity.
Article: [Gemeinsame Empfehlung der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe, Deutschen Gesellschaft für Kinder- und Jugendmedizin, Deutschen Gesellschaft für Perinatale Medizin, Akademie für Ethik in der Medizin, Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin unter Mitwirkung des Deutschen Hebammenverbandes und des Bundesverbandes "Das frühgeborene Kind"].Zeitschrift für Geburtshilfe und Neonatologie 02/2015; 219(1):12-9. DOI:10.1055/s-0034-1395575 · 0.46 Impact Factor
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ABSTRACT: Objective: To evaluate the maternal and perinatal outcomes of pregnancies delivered at 23+0 to 23+6 weeks’ gestation. Methods: This prospective cohort study included women in the Canadian Perinatal Network who were admitted to one of 16 Canadian tertiary perinatal units between August 1, 2005, and March 31, 2011, and who delivered at 23+0 to 23+6 weeks’ gestation. Women were included in the network if they were admitted with spontaneous preterm labour with contractions, a short cervix without contractions, prolapsing membranes with membranes at or beyond the external os or a dilated cervix, preterm premature rupture of membranes, intrauterine growth restriction, gestational hypertension, or antepartum hemorrhage. Maternal outcomes included Caesarean section, placental abruption, and serious complication. Perinatal outcomes were mortality and serious morbidity. Results: A total of 248 women and 287 infants were included in the study. The rate of Caesarean section was 10.5% (26/248) and 40.3% of women (100/248) had a serious complication, the most common being chorioamnionitis (38.6%), followed by blood transfusion (4.5%). Of infants with known outcomes, perinatal mortality was 89.9% (223/248) (stillbirth 23.3% [67/287] and neonatal death 62.9% [156/248]). Of live born neonates with known outcomes (n = 181), 38.1% (69/181) were admitted to NICU. Of those admitted to NICU, neonatal death occurred in 63.8% (44/69). Among survivors at discharge, the rate of severe brain injury was 44.0% (11/25), of retinopathy of prematurity 58.3% (14/24), and of any serious neonatal morbidity 100% (25/25). Two subgroup analyses were performed: in one, antepartum stillbirths were excluded, and in the other only centres that indicated they offered fetal monitoring at 23 weeks’ gestation were included and antepartum stillbirths were excluded. In each of these, perinatal outcomes similar to the overall group were found. Conclusion: Pregnant women delivering at 23 weeks’ gestation are at risk of morbidity. Their infants have high rates of serious morbidity and mortality. Further research is needed to identify strategies and forms of management that not only increase perinatal survival but also reduce morbidities in these extremely low gestational age infants and reduce maternal morbidity.Journal of obstetrics and gynaecology Canada: JOGC = Journal d'obstetrique et gynecologie du Canada: JOGC 03/2015; 37(3):214-24.
Article: [In Process Citation].Zeitschrift für Geburtshilfe und Neonatologie 12/2014; 218(6):267-8. DOI:10.1055/s-0034-1395688 · 0.46 Impact Factor