Purpose To determine outcomes and resuscitation decisions for extremely premature infants (EPI) of gestational ages between 23 and 24 weeks.
Methods A retrospective chart review of EPI born at the University Hospital, in Albuquerque, NM was performed for the years 1995-2002. Inclusion criteria were 1) gestational age (GA) of 23-24 weeks with at least fair dating, 2) heartbeat at onset of labor, and 3) labor was not for the purpose of termination. Maternal demographic data, infant characteristics, and counseling information were double entered into EPI INFO VI, which was also used to perform statistical analysis.
Results Of 116 deliveries identified by a database, 67 mothers and their 79 infants met our inclusion criteria. 56 were singleton gestations, 18 were twins and 5 were triplets. In general 28 infants (35.4%) survived to discharge, and 51 infants (64.6%) died before discharge. Maternal characteristics with respect to infant survival and degree of resuscitation were not significantly different in insurance type, ethnicity, alcohol, tobacco, or drug use, mode of delivery, or antenatal medications. Infant characteristics with respect to survival and degree of resuscitation were not significantly different in number of gestations or gender. Gestational age (GA), weight, and APGAR were significantly related to survival [GA: 23 wks 21% survived to discharge, 24 wks 46% survived, p=0.03; weight: 10% ≤600g survived, 57% ≥700g, p≤0.001; APGAR: 15.5% with 5 min score ≤5 survived to discharge, 61.7% with 5 min score ≥5 survived, p≤0.0001]. Increasing weight and APGAR were significantly related to decision to resuscitate [weight: 48% ≤600g were not resuscitated, 8.3% ≥700g were not resuscitated, p≤0.001; APGAR: 40% with 5 min score ≤5 were not resuscitated, 3% with 5 min score ≥5 were not resuscitated, p≤0.0001].
Conclusion The overall survival rate for EPI between 23 and 24 weeks gestation in this series was 35.4%. These data may assist clinicians and patients in making antenatal decisions about resuscitation of extremely premature infants.