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Author ORCID Identifier

0000-0001-6826-5337 (Morshedi)

0000-0002-9395-0907 (Griffiths-Randolph)

0000-0003-1980-5469 (Baraki)

0000-0003-1327-8979 (Martins)

0000-0002-1047-8003 (Warsof)

DOI

10.25884/jam1-gp21

Document Type

Original Research

Subcategory

Perinatology

Abstract

Background: The average rate of preterm birth in the US in 2021 was 10.1%. Although the rate of mortality from preterm birth has been decreasing, complications remain the leading cause of death in infants under the age of 5 years worldwide. Gestational age (GA) and birth weight (BW) remain the 2 most important variables for predicting survivability in preterm births, and lower GA and BW are both correlated with lower survivability.

Objective: To explore outcomes of neonates born in the periviable period (20 weeks and 0 days to 25 weeks and 6 days) with BW ≤ 500 g and to compare these data to existing national and international data to facilitate future counseling and management prior to delivery.

Study Design: A retrospective cohort study was performed at a single tertiary care center examining periviable neonates born between 2007 and 2018. Neonates were excluded if born on or after GA 26 weeks and 0 days or with BW > 500 g. Data were excluded if delivery or intrauterine fetal demise occurred prior to hospital admission. Twin gestations were included. Differences between groups were calculated using the Mann–Whitney U test with a two-tailed hypothesis and the chi-square test.

Results: We studied 200 maternal–neonatal dyads who were identified from chart review; 102 met inclusion criteria and 98 were excluded. Of those excluded, 97 were excluded for BW > 500 g, and 1 was excluded for delivery at home. Neonatal resuscitation was desired and attempted on 40/102 (39.2%) of patients. All 62 neonates born with a heartbeat who did not receive resuscitation died within the first day of life. Successful neonatal resuscitation was obtained in 33/40 (82.5%) patients who desired it; 17/40 (42.5%) neonates survived to 28 days of life and 16/40 (40.0%) infants survived to 1 year. Cesarean delivery was performed for 14/16 (87.5%) of the neonates who survived to 1 year. All 16 neonates who survived to 1 year experienced neurodevelopmental or medical comorbidities from prematurity.

Conclusions: Most neonates born in the perviable period do not survive, and those who did had a very high likelihood of experiencing complications from prematurity. Intact survival without comorbidities is rare, and no data currently exist regarding the outcomes of these neonates at adulthood, or if the latter is reached.

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