Assistant professor University of South Alabama Mobile, Alabama, United States
Background: While the limit of viability is determined by fetal immaturity, set at 22 weeks, the lower limit for body size relies solely on technological capabilities. Unfortunately, there is currently no available information to assist parents in making informed decisions when faced with the premature birth of a periviable infant (≤25 weeks of gestation) weighing < 400 grams. Objective: To assess the effects of perinatal factors on survival and morbidity rates in periviable infants with birth weight (BW) < 400 grams. Design/Methods: In this retrospective, single-center study, we included all periviable infants with a BW < 400 grams born between January 2009 and December 2020, managed at our institution, and whose parents requested neonatal interventions. We collected perinatal factors at birth, major morbidities before discharge, and neurodevelopmental (ND) outcomes at 2 years. The primary outcome was survival to discharge among infants who received active treatment. Major morbidities were defined as the presence of bronchopulmonary dysplasia grade 3, Severe intraventricular hemorrhage (grades 3 or 4), or type I Retinopathy of Prematurity. ND impairment was diagnosed if it included moderate or severe cerebral palsy, deafness, blindness, or a cognitive composite score < 85. Results: Of the initial 65 infants, 8 were excluded (6 for no intervention as per parental request and 2 for chromosomal anomalies). Among the 57 included infants, the majority were female (74%), singletons (73%), and delivered via cesarian section (84%). All infants were small for gestational age. Of these infants, 28 (49%) survived, with only 7 having no major morbidity. After adjustment through multivariate analysis, advanced gestational age remained the sole perinatal factor associated with improved survival [Adjusted relative risk: 1.28, 95% confidence interval: 1.02-1.61, P=0.03]. Among the 18 infants who underwent ND assessment, 11 (61%) exhibited moderate to severe ND impairment.
Conclusion(s): Our findings emphasize the significance of gestational age in discussions between healthcare providers and parents regarding the resuscitation of periviable infants with birth weights < 400 grams.
