The Limit of Viability -- Neonatal Outcome of Infants Born at 22 to 25 Weeks' Gestation

Allen, Marilee C; Donohue, Pamela; Dusman, Amy E.

doi:10.1056/nejm199311253292201

Cited by 419 publications

(182 citation statements)

References 21 publications

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“…At the same time, the GA at which 50% or more infants survived decreased from 28 to 23 weeks. Similar results have been reported by Allen et al 21 in 1993 and Hack et al 23 in 1995 with 56% and 54% survival at 24 weeks GA. Survival for the infants presented by O'Shea et al 24 in 1997 increased from 31% at 23 weeks to 63% at 24 weeks.…”

supporting

confidence: 89%

Nursery Survival for Infants of Birth Weight 500–1500 Grams During 1982–1995

et al. 2001

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supporting

confidence: 89%

Nursery Survival for Infants of Birth Weight 500–1500 Grams During 1982–1995

et al. 2001

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“…[8][9][10][11][12] In an earlier study, although approximately 10% of neonates born at 22 weeks' gestation survived to admission to the NICU, none of them were alive by 6 months of age. 18 In more recent studies, none of the infants born at <23 weeks were reported to survive to discharge from the NICU. [19][20] It appears that these findings, and perhaps the practicing neonatologists' own experiences, have influenced the approach to the management provided in the delivery room to the smallest and most immature neonates, as a recent survey of academic and private neonatologists in the United States has found that only 4% of the participants would resuscitate a neonate at 23 weeks' gestation with a birth weight of <500 g. 12 It further states that 57% of the responders would provide comfort care only, and 36% would defer the decision to parental wishes for these extremely immature infants.…”

Section: Resultsmentioning

confidence: 97%

Limits of viability: definition of the gray zone

2008

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Introduction: As survival and long-term morbidity of very preterm infants have improved over the past decade, the limits of infant viability, the level of maturity below which survival and/or acceptable neurodevelopmental outcome are extremely unlikely, have also decreased. Study Design:In an effort to define the current limits of infant viability, the data in the literature on survival and long-term neurodevelopmental outcome in very preterm neonates have been reviewed. Result:The gestational age and birth weight below which infants are too immature to survive, and thus provision of intensive care is unreasonable, appears to be at <23 weeks and <500 g, respectively. Infants born at X25 weeks' gestation and with a birth weight of X600 g are mature enough to warrant initiation of intensive care, as the majority of these patients survive, and at least 50% do so without severe long-term disabilities. Finally, for infants born between 23 0/7 and 24 6/7 weeks' gestation and with a birth weight of 500 to 599 g, survival and outcome are extremely uncertain. For these infants born in the so-called 'gray zone' of infant viability, the line between patient autonomy and medical futility is blurred, and medical decision-making becomes even more complex and needs to embrace careful consideration of several factors. These factors include appraisal of prenatal data and the information obtained during consultations with the parents before delivery; evaluation of the patient's gestational age, birth weight and clinical condition upon delivery; ongoing reassessment of the patient's response to resuscitation and intensive care and continued involvement of the parents in the decision-making process after delivery.Conclusion: Based on these findings an algorithm is offered for consideration for neonatologists managing infants born in the 'gray zone' of infant viability. However, caution must be exercised when one considers incorporating this guideline into clinical practice because the algorithm is based on the analysis of the findings in the literature and the authors' experience rather than direct evidence.

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“…2 In addition, most previous reports were not population based, as they examined pooled data over several years of a small number of infants who were treated in different ways. [3][4][5][6][7] The aim of the present study was to examine GAspecific outcomes of a large population-based cohort of infants who were born at Յ26 weeks' gestation and cared for in all 19 perinatal centers of Belgium between January 1999 and December 2000 and to compare the results with those of other geographic GA-based cohorts available in the literature. [8][9][10][11][12][13][14][15] …”

mentioning

confidence: 99%

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

Vanhaesebrouck

Allegaert²,

Bottu³

et al. 2004

Pediatrics

182

123

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ABSTRACT. Objective. To determine mortality and morbidity at discharge from the hospital of a large population-based cohort of infants who were born at <26 weeks' gestation.Methods. Perinatal data were collected on extremely preterm infants who were alive at the onset of labor and born between January 1, 1999, and December 31, 2000, in all 19 Belgian perinatal centers.Results. A total of 525 infants were recorded. Lifesupporting care was provided to 322 liveborn infants, 303 of whom were admitted for intensive care. The overall survival rate of liveborn infants was 54%. Of the infants who were alive at the age of 7 days, 82% survived to discharge. Vaginal delivery, shorter gestation, air leak, longer ventilator dependence, and higher initial oxygen need all were independently associated with death; gender, plurality, and surfactant therapy were not. Among the 175 survivors, 63% had 1 or more of the 3 major adverse outcome variables at the time of discharge (serious neuromorbidity, chronic lung disease at 36 weeks' postmenstrual age, or treated retinopathy of prematurity). The chance of survival free from serious neonatal morbidity at the time of hospital discharge was <15% (21 of 158) for the admitted infants with a gestation <26 weeks.Conclusions. If for the time being prolongation of pregnancy is unsuccessful, then outcome perspectives should be discussed and treatment options including nonintervention explicitly be made available to parents of infants of <26 weeks' gestation within the limits of medical feasibility and appropriateness. Pediatrics 2004; 114:663-675; extreme prematurity, mortality, morbidity, population-based cohort.

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The Limit of Viability -- Neonatal Outcome of Infants Born at 22 to 25 Weeks' Gestation

Cited by 419 publications

References 21 publications

Nursery Survival for Infants of Birth Weight 500–1500 Grams During 1982–1995

Nursery Survival for Infants of Birth Weight 500–1500 Grams During 1982–1995

Limits of viability: definition of the gray zone

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

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