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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica


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Volume 46, Issue 1

Issues

Proactive approach at the limits of viability improves the short-term outcome of neonates born after 23 weeks’ gestation

Patrik Šimják
  • Corresponding author
  • Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Apolinářská 18, 128-51, Prague 2, Czech Republic, Tel.: +420-224-967-012
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jan Smíšek
  • Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
  • Third Faculty of Medicine, Charles University, Prague, Czech Republic
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Michal Koucký
  • Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Tereza Lamberská
  • Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Richard Plavka
  • Division of Neonatology, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Zdeněk Hájek
  • Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2017-03-27 | DOI: https://doi.org/10.1515/jpm-2016-0264

Abstract

Objective:

The aim of this single-center study was to identify factors that affect the short-term outcome of newborns delivered around the limits of viability.

Methods:

A group of 137 pregnant women who gave birth between 22+0/7 and 25+6/7 weeks of gestation was retrospectively studied. The center supports a proactive approach to infants around the limits of viability. Perinatal and neonatal characteristics were obtained and statistically evaluated.

Results:

A total of 166 live-born infants were enrolled during a 6-year period; 162 (97.6%) of them were admitted to the neonatal intensive care unit (ICU) and 119 (73.5%) survived until discharge. The decrease in neonatal mortality was associated with an advanced gestational age (P<0.001) and a completed course of corticosteroids (P=0.002). Neonatal morbidities were common among infants of all gestational ages. The incidence of severe intraventricular hemorrhage significantly depended on gestational age (P<0.001) and a completed course of corticosteroids (P=0.002). Survival without severe neonatal morbidities was 39.5% and occurred mostly after 24+0/7 weeks of gestation.

Conclusion:

The short-term outcome of newborns delivered around the limits of viability is mostly affected by gestational age and antenatal corticosteroid treatment. A consistently proactive approach improves the survival of infants at the limits of viability. This is most pronounced in cases where the delivery is delayed beyond 24 completed gestational weeks.

Keywords: Gray zone; limits of viability; neonatal morbidity; neonatal mortality; preterm delivery; proactive approach

References

  • [1]

    The Victorian Infant Collaborative Study Group. Neonatal intensive care at borderline viability – is it worth it? E Hum Develop. 2004;80:103–13.Google Scholar

  • [2]

    Seri I, Evans J. Limits of viability: definition of the gray zone. J Perinatol. 2008;28:4–8.Web of ScienceCrossrefGoogle Scholar

  • [3]

    Larroque B, Breart G, Kaminski M, Dehan M, André M, Burguet A, et al. Survival of very preterm infants: epipage, a population based cohort study. Arch Dis Child Fetal Neonatal Ed. 2004;89:139–44.CrossrefGoogle Scholar

  • [4]

    Carlo WA, McDonald SA, Fanaroff AA, Vohr BR, Stoll BJ, Ehrenkranz RA, et al. Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks’ gestation. J Am Med Assoc. 2011;306:2348–58.Web of ScienceCrossrefGoogle Scholar

  • [5]

    Ishii N, Kono Y, Yonemoto N, Kusunda S, Fujimura M. Outcomes of infants born at 22 and 23 weeks’ gestation. Pediatrics. 2013;132:62–71.Web of ScienceCrossrefPubMedGoogle Scholar

  • [6]

    Tyson JE, Parikh NA, Langer J, Green C, Higgins RD. Intensive care for extreme prematurity-moving beyond gestational age. N Engl J Med. 2008;358:1672–81.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [7]

    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;126:443–56.Web of SciencePubMedGoogle Scholar

  • [8]

    NICHD Neonatal Research Network. Early-childhood neurodevelopmental outcomes are not improving for infants born at <25 weeks’ gestational age. Pediatrics. 2011;127:62–70.Web of SciencePubMedGoogle Scholar

  • [9]

    Victorian Infant Collaborative Study Group. Outcomes at age 2 years of infants, 28 weeks’ gestational age born in Victoria in 2005. J Pediatr. 2010;156:49–53.PubMedGoogle Scholar

  • [10]

    Kutz P, Horsch S, Kühn L, Roll C. Single- centre vs. population-based outcome data of extremely preterm infants at the limits of viability. Acta Paediatr. 2009;98:1451–5.Web of SciencePubMedCrossrefGoogle Scholar

  • [11]

    European Association of Perinatal Medicine. European consensus guidelines on the management of neonatal respiratory distress syndrome in preterm infants-2013 update. Neonatology. 2013;103:353–68.PubMedWeb of ScienceGoogle Scholar

  • [12]

    McCrea HJ, Ment LR. The diagnosis, management, and postnatal prevention of intraventricular hemorrhage in the preterm neonate. Clin Perinatol. 2008;35:777–72.PubMedCrossrefWeb of ScienceGoogle Scholar

  • [13]

    Neu J. Necrotizing enterocolitis. World Rev Nutr Diet. 2014;110:253–63.CrossrefPubMedGoogle Scholar

  • [14]

    Gordon PV, Attridge JT. Understanding clinical literature relevant to spontaneous intestinal perforations. Am J Perinatol. 2009;26:309–16.Web of SciencePubMedCrossrefGoogle Scholar

  • [15]

    Shane AL, Stoll BJ. Recent developments and current issues in the epidemiology, diagnosis, and management of bacterial and fungal neonatal sepsis. Am J Perinatol. 2013;30:131–41.CrossrefWeb of SciencePubMedGoogle Scholar

  • [16]

    Bancalari E, Claure N. Definitions and diagnostic criteria for bronchopulmonary dysplasia. Semin Perinatol. 2006;30:164–70.PubMedCrossrefGoogle Scholar

  • [17]

    International Committee for the classification of retinopathy of prematurity. The international classification of retinopathy of prematurity revisited. Arch Ophthalmol. 2005;123:991–9.PubMedGoogle Scholar

  • [18]

    Smith PB, Ambalavanan N, Li L, Cotten CM, Laughon M, Walsh MC, et al. Approach to infants born at 22 to 24 weeks’ gestation: relationship to outcomes of more-mature infants. Pediatrics. 2012;129:1508–16.CrossrefWeb of ScienceGoogle Scholar

  • [19]

    Crane JM, Magee LA, Lee T, Synnes A, Von Dadelszen P, Dahlgren L, et al. Maternal and perinatal outcomes of pregnancies delivered at 23 weeks’ gestation. J Obstet Gynaecol Can. 2015;37:214–24.CrossrefPubMedGoogle Scholar

  • [20]

    Marlow N, Bennett C, Draper ES, Hennessy EM, Morgan AS, Costeloe KL. Perinatal outcomes for extremely preterm babies in relation to place of birth in England: the EPICure 2 study. Arch Dis Child Fetal Neonatal Ed. 2014;99:181–8.Web of ScienceCrossrefGoogle Scholar

  • [21]

    EXPRESS Group. One-year survival of extremely preterm infants after active perinatal care in Sweden. J Am Med Assoc. 2009;301:2225–33.Google Scholar

  • [22]

    Su BH, Hsieh WS, Hsu CH, Chang JH, Lien R, Lin CH. Neonatal outcomes of extremely preterm infants from Taiwan: comparison with Canada, Japan, and the USA. Pediatr Neonatol. 2015;56:46–52.CrossrefPubMedWeb of ScienceGoogle Scholar

  • [23]

    Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010;126:443–56.Web of ScienceCrossrefPubMedGoogle Scholar

  • [24]

    Boland RA, Davis PG, Dawson JA, Doyle LW. Outcomes of infants born at 22–27 weeks’ gestation in Victoria according to outborn/inborn birth status. Arch Dis Child Fetal Neonatal. 2017;102:153–61.Web of ScienceCrossrefGoogle Scholar

  • [25]

    Deulofeut R, Sola A, Lee B, Buchter S, Rahman M, Rodigo M, et al. The impact of vaginal delivery in premature infants weighing less than 1,251 grams. Obstet Gynecol. 2005;105:525–31.CrossrefPubMedGoogle Scholar

  • [26]

    Lee HC, Gould J. Survival advantage associated with cesarean delivery in very low birth weight vertex neonates. Obstet Gynecol. 2006;107:97–105.PubMedWeb of ScienceCrossrefGoogle Scholar

  • [27]

    Riskin A, Riskin-Mashiah S, Lusky A, Reichman B; Israel Neonatal Network. The relationship between delivery mode and mortality in very low birthweight singleton vertex-presenting infants. Br J Obstet Gynecol. 2004;111:1365–71.CrossrefGoogle Scholar

  • [28]

    Običan SG, Small A, Smith D, Levin H, Drassinower D, Gyamfi-Bannerman C. Mode of delivery at periviability and early childhood neurodevelopment. Am J Obstet Gynecol. 2015;213:578.e1–4.CrossrefGoogle Scholar

  • [29]

    Bottoms SF, Paul RH, Iams JD, Mercer BM, Thom EA, Roberts JM, et al. Obstetric determinants of neonatal survival: influence of willingness to perform cesarean delivery on survival of extremely low-birth-weight infants. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol. 199;176:960–6.Google Scholar

  • [30]

    Lee Y, Kim HJ, Choi SJ, Oh SY, Kim JS, Roh CR, et al. Is there a stepwise increase in neonatal morbidities according to histological stage (or grade) of acute chorioamnionitis and funisitis?: effect of gestational age at delivery. J Perinat Med. 2015;43:259–67.Web of ScienceGoogle Scholar

  • [31]

    Korzeniewski SJ, Romero R, Cortez J, Pappas A, Schwartz AG, Kim CJ, et al. A “multi-hit” model of neonatal white matter injury: cumulative contributions of chronic placental inflammation, acute fetal inflammation and postnatal inflammatory events. J Perinat Med. 2014;42:731–43.Web of ScienceGoogle Scholar

  • [32]

    Canadian Neonatal Network. Prediction of neonatal outcomes in extremely preterm neonates. Pediatrics 2013;132:876–85.Web of ScienceGoogle Scholar

  • [33]

    Bolisetty S, Dhawan A, Abdel-Latif M, Bajuk B, Stack J, Lui K, et al. Intraventricular hemorrhage and neurodevelopmental outcomes in extreme preterm infants. Pediatrics. 2014;133:55–62.CrossrefPubMedWeb of ScienceGoogle Scholar

About the article

Corresponding author: MUDr. Patrik Šimják, Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Faculty of Medicine, Charles University, Prague, Apolinářská 18, 128-51, Prague 2, Czech Republic, Tel.: +420-224-967-012


Received: 2016-08-08

Accepted: 2017-02-22

Published Online: 2017-03-27

Published in Print: 2018-01-26


Author’s statement

Conflict of interest: Authors state no conflict of interest.

Material and methods: Informed consent: Informed consent has been obtained from all individuals included in this study.

Ethical approval: The research related to human subject use has complied with all the relevant national regulations, and institutional policies, and is in accordance with the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional review board or equivalent committee.


Citation Information: Journal of Perinatal Medicine, Volume 46, Issue 1, Pages 103–111, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2016-0264.

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