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Original Investigation |

Survival Among Infants Born at 22 or 23 Weeks’ Gestation Following Active Prenatal and Postnatal Care

Katrin Mehler, MD1; André Oberthuer, MD1; Titus Keller, MD1; Ingrid Becker2; Markus Valter, MD3; Bernhard Roth, MD1; Angela Kribs, MD1
[+] Author Affiliations
1Division of Neonatology, Children’s Hospital, University of Cologne, Cologne, Germany
2Institute of Medical Statistics, Informatics, and Epidemiology, University of Cologne, Cologne, Germany
3Department of Gynecology and Obstetrics, University of Cologne Medical Centre, Cologne, Germany
JAMA Pediatr. 2016;170(7):671-677. doi:10.1001/jamapediatrics.2016.0207.
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Importance  Rates of survival for infants born at the border of viability are still low and vary considerably among neonatal intensive care units.

Objective  To determine whether higher survival rates and better short-term outcomes for infants born at 22 or 23 weeks’ gestation may be achieved by active prenatal and postnatal care.

Design, Setting, and Participants  Retrospective study of 106 infants born at 22 or 23 weeks of gestation at a level III neonatal intensive care unit at the University of Cologne Medical Centre in Cologne, Germany, between January 1, 2010, and December 31, 2014. Data analysis was performed in June 2015.

Exposures  Active prenatal and postnatal care.

Main Outcomes and Measures  Survival until hospital discharge and survival without neonatal or short-term severe complications (defined as high-grade intraventricular hemorrhage, surgery for abdominal complications, bronchopulmonary dysplasia, or retinopathy of prematurity).

Results  Of 106 liveborn infants (45 born at 22 weeks and 61 born at 23 weeks and 6 days), 20 (19%) received palliative care (17 born at 22 weeks and 3 born at 23 weeks), and 86 (81%) received active care (28 born at 22 weeks and 58 born at 23 weeks). Of the 86 infants who received active care (mean [SD] maternal age, 32 [6] years), 58 (67%) survived until hospital discharge (17 born at 22 weeks and 41 born at 23 weeks). Eighty-five infants survived without severe complications, with 1 infant born at 22 weeks excluded because of missing data (6 of 27 [22%] born at 22 weeks, and 16 of 58 [28%] born at 23 weeks). Survival was predicted by the Apgar score after 5 minutes (odds ratio, 0.62 [95% CI, 0.46-0.84]) and birth weight (odds ratio, 0.001 [95% CI, 0.00-0.40]).

Conclusions and Relevance  One in 4 infants born at the border of viability and offered active care survived without severe complications. This finding should be considered for individualized parental approaches and decision making. Active follow-up information is required to determine childhood outcomes.

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