Management and outcomes of infants born at the limit of viability: experience from slovenian tertiary level perinatal centre
DOI:
https://doi.org/10.13112/pc.1191Keywords:
Infant, Extremely Premature; Fetal Viability; Survival RateAbstract
Aim: To evaluate rates of active management, mortality, and morbidity among periviable infants at a tertiary-level maternity hospital and to compare the results with those reported in the literature.
Methods: This single-center retrospective cohort study included mothers and their liveborn infants at gestational age of 22+0 to 24+6 weeks, born between 2015 and 2024. Clinical data regarding pregnancy, delivery, neonatal mortality, and major morbidities were collected from the Vermont Oxford Network database.
Results: A total of 177 liveborn infants with gestational age from 22+0 to 24+6 weeks were included. As the most immature infants were not treated actively, 80% of infants born at 22 weeks' gestation died in the delivery room. Survival rates by gestational age were 10% at 22 weeks, 35% at 23 weeks, and 75% at 24 weeks. Among infants admitted to the neonatal intensive care unit (n = 135), 24% developed severe intraventricular hemorrhage (grade III or IV), 13% underwent abdominal surgery due to necrotizing enterocolitis, and 21% required laser treatment for severe retinopathy of prematurity. Of the 93 survivors, 45 (48%) were discharged home with supplemental oxygen.
Conclusions: At our center, which provides care for more than 90% of periviable newborns in Slovenia, outcomes for actively managed infants are comparable to those reported in the literature from developed countries. In the future, we will carefully consider implementing active antenatal care for pregnancies reaching a completed 22 weeks' gestation and will continue long-term follow-up of infants born at the threshold of viability.
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