National cohort of infants born before 24 gestational weeks showed increased survival rates but no improvement in neonatal morbidity

Abstract

Aim To describe survival and neonatal morbidities in infants born before 24 weeks of gestation during a 12‐year period. Methods Data were retrieved from national registries and validated in medical files of infants born before 24 weeks of gestation 2007–2018 in Sweden. Temporal changes were evaluated. Results In 2007–2018, 282 live births were recorded at 22 weeks and 460 at 23 weeks of gestation. Survival to discharge from hospital of infants born alive at 22 and 23 weeks increased from 20% to 38% (p = 0.006) and from 45% to 67% (p < 0.001) respectively. Caesarean section increased from 12% to 22% (p = 0.038) for infants born at 22 weeks. Neonatal morbidity rates in infants alive at 40 weeks of postmenstrual age (n = 399) were unchanged except for an increase in necrotising enterocolitis from 0 to 33% (p = 0.017) in infants born at 22 weeks of gestation. Bronchopulmonary dysplasia was more common in boys than girls, 90% versus 82% (p = 0.044). The number of infants surviving to 40 weeks doubled over time. Conclusion Increased survival of infants born before 24 weeks of gestation resulted in increasing numbers of very immature infants with severe neonatal morbidities likely to have a negative impact on long‐term outcome.

Issue highlights

“…A national Swedish study by Lundgren et al reported that the number of infants born before 24 weeks who survived to 40 weeks of postmenstrual age doubled from 2007 to 2018 1 . However, neonatal morbidity rates did not change.…”

Association of Survival at 22 Weeks’ Gestation With Use of Antenatal Corticosteroids and Mode of Delivery in the United States

“…1 Survival among live-born infants at 22 to 23 weeks' gestational age (GA) ranged from 10% to 38% during the same period. 1,2 Expert groups have varying recommendations on active resuscitation and provision of neonatal f Included no charge or other expected primary payers.…”

“…For every maternal death in the US, 1 approximately 60 pregnant individuals experience severe maternal morbidity (SMM), 2 an indicator of poor maternal outcomes and risk factor for mortality. Black individuals are twice as likely to experience SMM as White individuals, 3 mirroring disparities in maternal deaths.…”

“…Methods | This repeated cross-sectional study used microdata natality files (2009-2018) for 50 states and Washington, DC from the National Center for Health Statistics, 5 including 3 delivery-related SMM indicators: blood transfusion, eclampsia, and unplanned hysterectomy. 2 Data were analyzed from July 2021 to April 2022. The outcome was a binary indicator of any of these morbidities.…”

Decisions at the limit of viability

“…In this issue of Acta Paediatrica, Lundgren et al publish the Swedish experience on neonatal outcome after adopting proactive obstetric and neonatal interventions to salvage infants born as early as GA 22 and 23 weeks. 1 During 2007-2018, the stillbirth rate decreased for infants with GA 22 weeks, and the survival rates of liveborn infants increased from 19% to 38% for GA 22 weeks and from 45% to 67% for GA 23 weeks. The largest increase occurred from 2016 when a new national guideline stated that neonatal resuscitation should be considered from GA 22 weeks and recommended from 23 weeks.…”