Document Detail


The limit of viability--neonatal outcome of infants born at 22 to 25 weeks' gestation.
MedLine Citation:
PMID:  8179651     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: With improved survival of preterm infants, questions have been raised about the limit of viability. To provide better information and counseling for parents of infants about to be delivered after 22 to 25 weeks' gestation, we evaluated the mortality and neonatal morbidity of preterm infants born at these gestational ages. METHODS: We studied retrospectively all 142 infants born at 22 to 25 weeks' gestation (as judged by best obstetrical estimate) from May 1988 through September 1991 in a single hospital. Mortality in the first six months, including stillbirths, and neonatal morbidity (i.e., the presence of intracranial pathologic conditions, chronic lung disease, and retinopathy of prematurity) were analyzed. RESULTS: Fifty-six infants (39 percent) survived for six months. Survival improved with increasing gestational age; none of 29 infants born at 22 weeks' gestation survived, as compared with 6 of 40 (15 percent) born at 23 weeks, 19 of 34 (56 percent) born at 24 weeks, and 31 of 39 (79 percent) born at 25 weeks. There were seven stillbirths at 22 weeks' gestation and four stillbirths at 23 weeks. The more immature the infant, the higher the incidence of neonatal complications as determined by the number of days of mechanical ventilation, the length of the hospital stay, and the presence of retinopathy of prematurity, periventricular or intraventricular hemorrhage, or periventricular leukomalacia. Only 2 percent of infants born at 23 weeks' gestation survived without severe abnormalities on cranial ultrasonography, as compared with 21 percent of those born at 24 weeks and 69 percent of those born at 25 weeks. CONCLUSIONS: We believe that aggressive resuscitation of infants born at 25 weeks' gestation is indicated, but not of those born at 22 weeks. Whether the occasional child who is born at 23 or 24 weeks' gestation and does well justifies the considerable mortality and morbidity of the majority is a question that should be discussed by parents, health care providers, and society.
Authors:
M C Allen; P K Donohue; A E Dusman
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The New England journal of medicine     Volume:  329     ISSN:  0028-4793     ISO Abbreviation:  N. Engl. J. Med.     Publication Date:  1993 Nov 
Date Detail:
Created Date:  1993-12-01     Completed Date:  1993-12-01     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0255562     Medline TA:  N Engl J Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1597-601     Citation Subset:  AIM; IM    
Affiliation:
Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
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MeSH Terms
Descriptor/Qualifier:
Female
Fetal Death
Gestational Age
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / mortality*
Length of Stay
Male
Morbidity
Pregnancy
Pregnancy Outcome
Regression Analysis
Retrospective Studies
Comments/Corrections
Comment In:
N Engl J Med. 1994 Apr 28;330(17):1235; author reply 1235-6   [PMID:  8179694 ]
N Engl J Med. 1993 Nov 25;329(22):1649-50   [PMID:  8232435 ]
N Engl J Med. 1994 Apr 28;330(17):1234   [PMID:  8139636 ]
N Engl J Med. 1994 Apr 28;330(17):1234-5   [PMID:  8139637 ]
N Engl J Med. 1994 Apr 28;330(17):1235; author reply 1235-6   [PMID:  8139638 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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