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

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.

Massive Gastric Hemorrhage after Indomethacin Therapy: A Rare Presentation and Critical Management in an Extremely Preterm Infant

“…Recently, delayed cord clamping in term and preterm infants has been a simple, safe, and effective delivery procedure leading to the prevention of anemia and to improvements in infant condition [ 42 ]. In the unit of this reported infant, umbilical cord milking after birth is a routine for peri-viable infants [ 43 ] and may have a similar effect to delayed cord clamping [ 44 ].…”

“…A reduced total dose and a reduced rate of complications for indomethacin have been reported without a decreased rate of closure of the PDA. The study unit’s policy of PDA management was described in our previous report [ 43 ].…”

Postnatal Serum Total Thyroxine of Very Preterm Infants and Long-Term Neurodevelopmental Outcome

“…The annual care volume of this unit is approximately 350-400 neonatal admissions, including approximately 60 VPIs. Two neonatologists, two residents, and one nurse practitioner are regularly in charge of the admitted infants each month [18].…”

“…Data on respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), sepsis, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC) [21], retinopathy of prematurity (ROP), postnatal steroids therapy, chronic lung disease (CLD) [22], periventricular leukomalacia (PVL), duration of invasive ventilation, and postnatal steroid therapy for CLD, respiratory support status, PNA and postmenstrual age (PMA) were obtained at discharge [18,23].…”

“…Therefore, these findings might be not generalizable beyond this specific group. In particular, periviable infants (22-25 weeks GA) who undergo longer hospitalization should be separately and specifically focused upon (Supplementary Table S4) [18].…”