Survival and short-term outcome in newborns of 23 to 25 weeks' gestation

Abstract

OBJECTIVES: We determined which factors are associated with survival and good short-term neurologic outcome in newborns of 23 to 25 weeks' gestation. STUDY DESIGN: We retrospectively reviewed the charts of all (n = 82) infants born alive at our hospital at 23 to 25 weeks' gestation from 1988 through 1991. We used univariate and multiple logistic regression analysis to compare survivors at hospital discharge with nonsurvivors and those with and without good short-term neurologic outcome. RESULTS: Survival rates were 19%, 59%, and 65% at 23, 24, and 25 weeks' gestation, respectively. A total of 90% of survivors had good short-term neurologic outcome. On multiple logistic regression analysis, female sex (odds ratio 8.7, 95% confidence limits 2.2 and 34), larger birth weight (odds ratio 2.5 per 100 gm increment, 95% confidence limits 1.3 and 4.9), and more advanced gestational age (odds ratio 5.3, 95% confidence limits 1.2 and 22 for 24 weeks; odds ratio 3.8, 95% confidence limits 0.6 and 22 for 25 weeks) were associated with survival. Female sex, more advanced gestational age, and larger birth weight were also associated with good short-term neurologic outcome. CONCLUSIONS: Good short-term neurologic outcome is possible in many survivors in this gestational age range. Factors other than gestational age may be considered when intervention in these pregnancies is contemplated. OBJECTIVES: We determined which factors are associated with survival and good short-term neurologic outcome in newborns of 23 to 25 weeks' gestation. STUDY DESIGN: We retrospectively reviewed the charts of all (n = 82) infants born alive at our hospital at 23 to 25 weeks' gestation from 1988 through 1991. We used univariate and multiple logistic regression analysis to compare survivors at hospital discharge with nonsurvivors and those with and without good short-term neurologic outcome. RESULTS: Survival rates were 19%, 59%, and 65% at 23, 24, and 25 weeks' gestation, respectively. A total of 90% of survivors had good short-term neurologic outcome. On multiple logistic regression analysis, female sex (odds ratio 8.7, 95% confidence limits 2.2 and 34), larger birth weight (odds ratio 2.5 per 100 gm increment, 95% confidence limits 1.3 and 4.9), and more advanced gestational age (odds ratio 5.3, 95% confidence limits 1.2 and 22 for 24 weeks; odds ratio 3.8, 95% confidence limits 0.6 and 22 for 25 weeks) were associated with survival. Female sex, more advanced gestational age, and larger birth weight were also associated with good short-term neurologic outcome. CONCLUSIONS: Good short-term neurologic outcome is possible in many survivors in this gestational age range. Factors other than gestational age may be considered when intervention in these pregnancies is contemplated.