Outcomes of Infants Born at 22 and 23 Weeks’ Gestation

Ishii, Nozomi; Kono, Yumi; Yonemoto, Naohiro; Kusuda, Satoshi; Fujimura, Masanori; ,

doi:10.1542/peds.2012-2857

Cited by 230 publications

(165 citation statements)

References 50 publications

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“…30 Infants born at 22 weeks' gestation have reported rates of moderate to severe neurodevelopmental impairment of 85% to 90%; for infants born at 23 weeks' gestation, these rates are not significantly lower. [29][30][31][32] The risk of permanent, severe neurodevelopmental and other special health care needs affect both the infant and the family and, for some parents, may outweigh the benefit of survival alone. [33][34][35][36] …”

Section: Outcome According To Gestational Agementioning

confidence: 99%

Antenatal Counseling Regarding Resuscitation and Intensive Care Before 25 Weeks of Gestation

Cummings¹,

Watterberg²,

Eichenwald³

et al. 2015

Pediatrics

242

133

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The anticipated birth of an extremely low gestational age (<25 weeks) infant presents many difficult questions, and variations in practice continue to exist. Decisions regarding care of periviable infants should ideally be well informed, ethically sound, consistent within medical teams, and consonant with the parents’ wishes. Each health care institution should consider having policies and procedures for antenatal counseling in these situations. Family counseling may be aided by the use of visual materials, which should take into consideration the intellectual, cultural, and other characteristics of the family members. Although general recommendations can guide practice, each situation is unique; thus, decision-making should be individualized. In most cases, the approach should be shared decision-making with the family, guided by considering both the likelihood of death or morbidity and the parents’ desires for their unborn child. If a decision is made not to resuscitate, providing comfort care, encouraging family bonding, and palliative care support are appropriate.

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Section: Outcome According To Gestational Agementioning

confidence: 99%

Antenatal Counseling Regarding Resuscitation and Intensive Care Before 25 Weeks of Gestation

Cummings¹,

Watterberg²,

Eichenwald³

et al. 2015

Pediatrics

242

133

View full text Add to dashboard Cite

show abstract

“…Our data sources capture all hospital childbirths in the province, defined as delivery of an infant at a gestational age of $20 weeks. 38,39 For the purpose of defining a baseline period in which to assess comorbid conditions, we assigned an index date to each woman that was 42 weeks prior to delivery, which represents the longest term gestational duration. Prepregnancy characteristics were assessed in the 5 years prior to the index date and pregnancy outcomes were assessed between the index date and 12 weeks after delivery (or 17 weeks for dialysis dependence).…”

Section: Populationmentioning

confidence: 99%

Characteristics and Outcomes of AKI Treated with Dialysis during Pregnancy and the Postpartum Period

Hildebrand

Liu

Shariff

et al. 2015

Journal of the American Society of Nephrology

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Acute kidney injury (AKI) is a rare complication of pregnancy, but may be associated with significant morbidity and mortality in young and often otherwise healthy women. We conducted a retrospective population-based cohort study of all consecutive pregnancies over a 15-year period (1997-2011) in Ontario, Canada, and describe the incidence and outcomes of AKI treated with dialysis during pregnancy or within 12 weeks of delivery. Of 1,918,789 pregnancies, 188 were complicated by AKI treated with dialysis (incidence: 1 per 10,000 [95% confidence interval, 0.8 to 1.1]). Only 21 of 188 (11.2%) women had record of a preexisting medical condition; however, 130 (69.2%) women experienced a major pregnancy-related complication, including preeclampsia, thrombotic microangiopathy, heart failure, sepsis, or postpartum hemorrhage. Eight women died (4.3% versus 0.01% in the general population), and seven (3.9%) women remained dialysis dependent 4 months after delivery. Low birth weight (,2500 g), small for gestational age, or preterm birth (,37 weeks' gestation) were more common in pregnancies in which dialysis was initiated (35.6% versus 14.0%; relative risk, 3.40; 95% confidence interval, 2.52 to 4.58). There were no stillbirths and fewer than five neonatal deaths (,2.7%) in affected pregnancies compared with 0.1% and 0.8%, respectively, in the general population. In conclusion, AKI treated with dialysis during pregnancy is rare and typically occurs in healthy women who acquire a major pregnancy-related medical condition such as preeclampsia. Many affected women and their babies have good short-term outcomes. 26: 3085-3091, 201526: 3085-3091, . doi: 10.1681 Pregnancy-related AKI is associated with significant morbidity and mortality inyoung and often otherwise healthy women. 1,2 Since the 1960s, the incidence of pregnancy-related AKI in developed countries has declined from 1 in 3000 to 1 in 18,000. 1 This trend has been closely linked to improved obstetrical care and dramatic reductions in first-trimester AKI attributable to septic abortions. 2 However, these trends are less relevant in contemporary populations. The changing risk profile of pregnant North American women includes lower parity, older age, higher body mass index, and greater comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease, as well as increased use of reproductive technologies resulting in multiple gestations. These changes may have a unique impact on the incidence, etiology, and outcomes of pregnancy-related AKI. [3][4][5][6][7] J Am Soc Nephrol

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“…[4][5][6] This trend is consistent across studies, but the absolute rates of mortality and morbidity vary most markedly for those infants born at the earliest gestational weeks. 1,[4][5][6][7][8][9][10][11][12][13][14] Similarly, resuscitation practices at <26 weeks vary greatly by country, hospital, and practitioner 4,9,11,15 because there is no consensus on a precise "limit of viability" (defined as anywhere between 22 and 26 weeks). [16][17][18] The summary from a 2013 joint workshop held by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for MaternalFetal Medicine, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists acknowledged the wide variation in practices and outcomes for infants born at <26 weeks' gestation.…”

mentioning

confidence: 99%

Survival and Major Morbidity of Extremely Preterm Infants: A Population-Based Study

et al. 2016

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OBJECTIVES: To assess the rates of mortality and major morbidity among extremely preterm infants born in California and to examine the rates of neonatal interventions and timing of death at each gestational age. METHODS:A retrospective cohort study of all California live births from 2007 through 2011 linked to vital statistics and hospital discharge records, whose best-estimated gestational age at birth was 22 through 28 weeks. Major morbidities were based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Survival beyond the first calendar day of life and procedure codes were used to assess attempted resuscitation after birth. RESULTS:A total of 6009 infants born at 22 through 28 weeks' gestation were included. Survival to 1 year for all live births ranged from 6% at 22 weeks to 94% at 28 weeks. Seventy-three percent of deaths occurred within the first week of life. Major morbidity was present in 80% of all infants, and multiple major morbidities were present in 66% of 22-and 23-week infants. Rates of resuscitation at 22, 23, and 24 weeks were 21%, 64%, and 93%, respectively. Survival after resuscitation was 31%, 42%, and 64% among 22-, 23-, and 24-week infants, respectively. Improved survival was associated with increased birth weight, female sex, and cesarean delivery (P < .01) for resuscitated 22-, 23-, and 24-week infants. CONCLUSIONS:In a population-based study of extreme prematurity, infants ≤24 weeks' gestation are at highest risk of death or major morbidity. These data can help inform recommendations and decision-making for extremely preterm births.

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Outcomes of Infants Born at 22 and 23 Weeks’ Gestation

Cited by 230 publications

References 50 publications

Antenatal Counseling Regarding Resuscitation and Intensive Care Before 25 Weeks of Gestation

Antenatal Counseling Regarding Resuscitation and Intensive Care Before 25 Weeks of Gestation

Characteristics and Outcomes of AKI Treated with Dialysis during Pregnancy and the Postpartum Period

Survival and Major Morbidity of Extremely Preterm Infants: A Population-Based Study

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