Influence of Perinatal Factors in Short- and Long-Term Outcomes of Infants Born at 23 Weeks of Gestation

Abstract

Objective Investigate the influence of perinatal factors on short- and long-term outcomes for infants born at 23 weeks of gestation.

Study Design This is a retrospective study over a 25-year period (1987–2011) of 87 successfully resuscitated infants at 23 weeks of gestation. We investigated the effects of poor prenatal care, race, gender, chorioamnionitis, antenatal corticosteroids, delivery route/location, low 5-minute Apgar score, birth weight, and multiple births on short- and long-term outcomes.

Results The mortality rate was 43% (37/87). A total of 88% (44/50) of the survivors were followed at 2 years corrected age with 66% (29/44) diagnosed with a moderate-to-severe neurological impairment. Outborn and multiple birth infants had significantly higher mortality (p-value 0.042 and 0.006, respectively). Lack of exposure to antenatal steroids and lower birth weight significantly increased the disability score (p-value 0.042 and 0.003, respectively).

Conclusion Multiple perinatal factors significantly influence outcomes at the threshold of viability.

Keywords

neonatal outcome - periviable birth - risk factors - survival

• References

• 1 Fanaroff AA, Hack M, Walsh MC. The NICHD neonatal research network: changes in practice and outcomes during the first 15 years. Semin Perinatol 2003; 27 (4) 281-287
• 2 Peerzada JM, Richardson DK, Burns JP. Delivery room decision-making at the threshold of viability. J Pediatr 2004; 145 (4) 492-498
• 3 Singh J, Fanaroff J, Andrews B , et al. Resuscitation in the “gray zone” of viability: determining physician preferences and predicting infant outcomes. Pediatrics 2007; 120 (3) 519-526
• 4 Lucey JF, Rowan CA, Shiono P , et al. Fetal infants: the fate of 4172 infants with birth weights of 401 to 500 grams—the Vermont Oxford Network experience (1996-2000). Pediatrics 2004; 113 (6) 1559-1566
• 5 Salihu HM, Salinas-Miranda AA, Hill L, Chandler K. Survival of pre-viable preterm infants in the United States: a systematic review and meta-analysis. Semin Perinatol 2013; 37 (6) 389-400
• 6 Cuevas KD, Silver DR, Brooten D, Youngblut JM, Bobo CM. The cost of prematurity: hospital charges at birth and frequency of rehospitalizations and acute care visits over the first year of life: a comparison by gestational age and birth weight. Am J Nurs 2005; 105 (7) 56-64 , quiz 65
• 7 Ishii N, Kono Y, Yonemoto N, Kusuda S, Fujimura M ; Neonatal Research Network, Japan. Outcomes of infants born at 22 and 23 weeks' gestation. Pediatrics 2013; 132 (1) 62-71
• 8 Chauhan SP, Ananth CV. Periviable births: epidemiology and obstetrical antecedents. Semin Perinatol 2013; 37 (6) 382-388
• 9 Muraskas J, Marshall PA, Tomich P, Myers TF, Gianopoulos JG, Thomasma DC. Neonatal viability in the 1990s: held hostage by technology. Camb Q Healthc Ethics 1999; 8 (2) 160-170 , discussion 170–172
• 10 Lantos JD, Meadow W. Variation in the treatment of infants born at the borderline of viability. Pediatrics 2009; 123 (6) 1588-1590
• 11 Carlo WA, McDonald SA, Fanaroff AA , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation. JAMA 2011; 306 (21) 2348-2358
• 12 Alfirevic Z, Milan SJ, Livio S. Caesarean section versus vaginal delivery for preterm birth in singletons. Cochrane Database Syst Rev 2013; 9: CD000078
• 13 Iams JD, Mercer BM ; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network. What we have learned about antenatal prediction of neonatal morbidity and mortality. Semin Perinatol 2003; 27 (3) 247-252
• 14 Nguyen TP, Amon E, Al-Hosni M, Gavard JA, Gross G, Myles TD. “Early” versus “late” 23-week infant outcomes. Am J Obstet Gynecol 2012; 207 (3) e1-e6
• 15 Soraisham AS, Singhal N, McMillan DD, Sauve RS, Lee SK ; Canadian Neonatal Network. A multicenter study on the clinical outcome of chorioamnionitis in preterm infants. Am J Obstet Gynecol 2009; 200 (4) e1-e6
• 16 Jobe AH. Antenatal associations with lung maturation and infection. J Perinatol 2005; 25 (Suppl. 02) S31-S35
• 17 Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 1978; 92 (4) 529-534
• 18 Bell MJ, Ternberg JL, Feigin RD , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187 (1) 1-7
• 19 Engle WA ; American Academy of Pediatrics Committee on Fetus and Newborn. Age terminology during the perinatal period. Pediatrics 2004; 114 (5) 1362-1364
• 20 Bayley N. Bayley Scales of Infant and Toddler Development, 3rd ed. San Antonio, TX: Harcourt Assessment, Inc; 2005
• 21 Hoekstra RE, Ferrara TB, Couser RJ, Payne NR, Connett JE. Survival and long-term neurodevelopmental outcome of extremely premature infants born at 23-26 weeks' gestational age at a tertiary center. Pediatrics 2004; 113 (1 Pt 1) e1-e6
• 22 Stoll BJ, Hansen NI, Bell EF , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (3) 443-456
• 23 Kyser KL, Morriss Jr FH, Bell EF, Klein JM, Dagle JM. Improving survival of extremely preterm infants born between 22 and 25 weeks of gestation. Obstet Gynecol 2012; 119 (4) 795-800
• 24 Batton DG, DeWitte DB, Pryce CJ. One hundred consecutive infants born at 23 weeks and resuscitated. Am J Perinatol 2011; 28 (4) 299-304
• 25 Hankins GD, Pacheco LD, Soo-Tung Wen T. Fetal assessment near the limits of viability. Semin Perinatol 2013; 37 (6) 401-403
• 26 Bader D, Kugelman A, Boyko V , et al; Israel Neonatal Network. Risk factors and estimation tool for death among extremely premature infants: a national study. Pediatrics 2010; 125 (4) 696-703
• 27 Hadlock FP, Harrist RB, Martinez-Poyer J. In utero analysis of fetal growth: a sonographic weight standard. Radiology 1991; 181 (1) 129-133
• 28 Hack M, Taylor HG, Drotar D , et al. Poor predictive validity of the Bayley Scales of Infant Development for cognitive function of extremely low birth weight children at school age. Pediatrics 2005; 116 (2) 333-341
• 29 Raju TNK, Mercer BM, Burchfield DJ, Joseph GF. Periviable birth: executive summary of a Joint Workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. J Perinatol 2014; 34 (5) 333-342