• Neonatology · Jan 2014

    Survival and neurodevelopmental outcome of preterm infants born at 22-24 weeks of gestational age.

    • Masayuki Ochiai, Tadamune Kinjo, Yasushi Takahata, Mariko Iwayama, Takeru Abe, Kenji Ihara, Shouichi Ohga, Kotaro Fukushima, Kiyoko Kato, Tomoaki Taguchi, and Toshiro Hara.
    • Comprehensive Maternity and Perinatal Care Center, Kyushu University Hospital, Fukuoka, Japan.
    • Neonatology. 2014 Jan 1;105(2):79-84.

    BackgroundThe limits of viability in extremely premature infants are challenging for any neonatologists in developed countries. The neurological development and growth of extremely preterm infants have come to be the emerging issue following the management in the neonatal intensive care unit.ObjectiveTo assess potential associations between changes in practice and survival/neurodevelopmental outcome, and clinical outcomes of extremely preterm infants born at the limit of viability studied in a tertiary center.Study DesignA retrospective study enrolled 51 infants who had no congenital disorders, and were born at 22-24 weeks of gestational age (GA) in 2000-2009 in our institution. Clinical variables and interventions were studied with regard to one-year survival and developmental quotient (DQ) at 3 years of age.ResultsThe one-year survival rate of 24 preterm infants born in 2005-2009 (79%) was higher than that of the 27 infants born in 2000-2004 (52%, p = 0.04). Infants born after 2005 underwent less tocolysis (54 vs. 94%, p < 0.01) and more frequently antenatal steroid therapy (32 vs. 6%, p = 0.01) than those born before 2004. The post-2005 survivors (n = 19) received more frequently indomethacin therapy (89 vs. 50%, p = 0.03) and early parenteral nutrition (95 vs. 36%, p < 0.01) than the pre-2004 survivors (n = 14). There were no differences in the proportion of infants who attained a DQ of >50 at 3 years of age between pre-2004 (9/13, 69%) and post-2005 groups (10/17, 59%). Multivariate analysis indicated that extremely premature birth at GA <24 weeks was the sole critical factor for a DQ of >50 in survivors.ConclusionsThe perinatal care after 2005 improved the overall survival rate, but not the neurological outcome of preterm survivors at the limit of viability. Neurodevelopmental impairments were associated with extremely premature birth at GA <24 weeks.© 2013 S. Karger AG, Basel.

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