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

  • Patrik Šimják EMAIL logo , Jan Smíšek , Michal Koucký , Tereza Lamberská , Richard Plavka and Zdeněk Hájek
Published/Copyright: March 27, 2017

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.


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

Author’s statement

  1. Conflict of interest: Authors state no conflict of interest.

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

  3. 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.

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Received: 2016-8-8
Accepted: 2017-2-22
Published Online: 2017-3-27
Published in Print: 2018-1-26

©2018 Walter de Gruyter GmbH, Berlin/Boston

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  19. Proactive approach at the limits of viability improves the short-term outcome of neonates born after 23 weeks’ gestation
  20. Letter to the Editor
  21. Exact days of gestation necessary for infants at borderline viability: reply to Proactive approach at the limits of viability improves the short-term outcome of neonates born after 23weeks’ gestation. P. Šimják, J. Smíšek, M. Koucký, T. Lamberská, R. Plavka and Z. Hájek. J Perinat Med 2017
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