532: ‘Early’ versus ‘late’ 23 week neonatal outcomes

Abstract

Erol Amon, Thinh Nguyen, Mohamad Al-Hosni, Jeffrey Gavard Saint Louis University, Obstetrics, Gynecology and Women’s Health, Division of Maternal-Fetal Medicine, Saint Louis, MO, Saint Louis University School of Medicine, Department of Pediatrics, Saint Louis, MO, Saint Louis University, Obstetrics, Gynecology and Women’s Health, Saint Louis, MO OBJECTIVE: To determine if there is a survival difference in 23 week neonates delivered ‘early’ (23 0/7 to 23 3/7 weeks) versus ‘late’ (23 4/7 to 23 6/7 weeks). STUDY DESIGN: Records of 126 consecutive live born infants between 23 0/7 and 23 6/7 weeks gestation treated at a single perinatal center over a 10 year period (2000 to 2010) were examined. These babies were divided into early and late 23 week deliveries . Statistical comparisons were made using chi-square and t-tests as appropriate (P .05) with regards to early or late delivery, antenatal steroid use, birthweight, Apgar score, location of delivery, cesarean delivery and neonatal complications and a composite of survival to discharge or first birthday. RESULTS: 72 infants were born ‘early’ and 54 were ‘late’. Overall, 38% of infants in our cohort survived to discharge or their first birthday. Survival was significantly different in the early (25%) versus late (56%) group (p 0.001). Moreover, there was a significant difference in mean birthweight between the two groups, 547 g for early group versus 596 g for the late group (p 0.001). Additionally, birthweight was noted to be an independent factor in predicting survival (p 0.001). The early group was less likely to have received antenatal steroids (43% vs. 65%; p 0.016). There was no difference in race, gender, multiple gestations, mean 1and 5-minute Apgar scores or delivery mode between the two groups. Neonatal outcomes, including RDS, NEC, chronic lung disease were not significantly different between the two groups. Year-by-year trend analysis did not show an improvement over the ten year study period in either group. CONCLUSION: Early 23 week babies have poorer survival compared to late 23 week babies. Despite the advances in obstetric and neonatal care, neither group showed improved survival over the last decade. These data suggest that delaying delivery even one or two days confers a significant survival benefit and that aggressive intervention may be warranted in this gestational age group.