Neonatal outcomes at the threshold of viability

Abstract

MATTHEW SAXONHOUSE, RODNEY EDWARDS, University of Florida, Obstetrics and Gynecology, Gainesville, Florida, University of Florida, Pediatrics, Gainesville, Florida OBJECTIVE: To estimate survival and intact survival of infants based on best obstetric estimate of gestational age (GA) and ultrasound estimate of fetal weight (EFW). STUDY DESIGN: We performed a retrospective cohort analysis of all deliveries at Shands Hospital at the University of Florida from 01/99-12/03. Mother-infant pairs were included if delivery occurred at 23-26 weeks GA or EFW less than 1000 g. Exclusion criteria were: either the medical staff or the pregnant considered the fetus non-viable prior to delivery, no timely delivery for fetal indications, multiple gestation, congenital anomalies or ‘‘TORCH’’ infection, chromosomal abnormality or genetic syndrome, or EFW not done within 7 days of delivery. Survival was defined as being alive at hospital discharge. ‘‘Intact’’ survival signified the absence of all of the following: oxygen requirement at O36 weeks corrected GA, grade III or IV intraventricular hemorrhage, periventricular leukomalacia, retinopathy of prematurity requiring laser treatment, necrotizing enterocolitis requiring surgical intervention, or evidence of hearing dysfunction. RESULTS: There were 112 mother-infant pairs included. Overall and intact survival stratified by GA and EFW are presented in the tables [n (%; 95% CI)]. The only infant surviving at 23 weeks and the only infant with intact survival less than 25 weeks had birth weights over 700 g. CONCLUSION: Even with timely delivery for fetal indications, intact survival is infrequent with either GA !25 weeks or EFW !700g.