Improved Survival of Periviable Infants after Alteration of the Threshold of Viability by the Neonatal Resuscitation Program 2015.

Yen-Ju Chen,Yung-Chieh Lin,Mohamed Hamed Hussein,Li-Wen Chen,Hui-Shan Lin,Chao-Ching Huang,Shin Kato,Wen-Hao Yu,Osuke Iwata,Lin Kang

doi:10.3390/children8010023

Abstract

Periviable infants (PIs) born at 22–25 weeks gestational age (wGA) have a variable survival rate (49.7–86.2%) among hospitals. One factor involved in this difference may be the definition of the threshold of viability. The American Academy of Pediatrics revised the neonatal resuscitation program in late 2015 (NRP 2015) and altered the threshold of viability from 23 to 22 wGA. The impact on the survival of PIs after the guideline alteration has seldom been discussed. Since 2016, the unit of this study has implemented the renewed guideline for PIs. We retrospectively reviewed and analyzed the survival and clinical variables of PIs before and after implementation of the guideline, which included a 10-year cohort in a single center in Taiwan. There were 168 PIs enrolled between 2010 and 2019 (Epoch-I, 2010–2015; Epoch-II, 2016–2019), after excluding those with congenital anomalies and parent-decided comfort care. Compared to those in Epoch-I, the PIs in Epoch-II had significantly higher odds ratios (2.602) (95% confidence interval: 1.170–5.789; p = 0.019) for survival. Younger gestational age, small size for gestational age, cesarean delivery, low blood pH at birth, and surfactant therapeutic treatment were found to be significant risk factors associated with the survival of PIs (p < 0.05 for each). The altered threshold of viability by NRP 2015 may impact the survival of PIs. However, long-term follow-up for surviving PI is required in the future.

Highlights

In recent years, researchers have become increasingly interested in the care of periviable infants [1,2,3]
In infants born at 22–23 weeks gestational age (wGA), the reported survival rate is from 8% to 70% for infants born at wGA [9,15] and from 25% to 75.4% for infants born at wGA [13,15]
Detailed data of all Periviable infants (PIs) born or transferred to the unit in which the study was conducted are provided in Supplemental Table S1

Summary

Introduction

Researchers have become increasingly interested in the care of periviable infants [1,2,3]. The care of periviable infants continues to challenge state-of-the-art medicine. Periviable birth is defined as delivery happening from 200/7 to 256/7 weeks gestational age (wGA) [4,5,6]. In the past two decades, there have been reports of increased rates of survival of periviable infants born at 22–25 wGA from single centers or large cohorts in Taiwan, Japan, USA, France, Germany, and Australia [7,8,9,10,11,12,13,14]. The reported survival rate of periviable infants varied between reports (49.7–86.2%) [9,11,15]. In infants born at 22–23 wGA, the reported survival rate is from 8% to 70% for infants born at wGA [9,15] and from 25% to 75.4% for infants born at wGA [13,15]

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