Universität zu Köln

Mehler, Katrin, Oberthuer, Andre, Keller, Titus, Becker, Ingrid ORCID: 0000-0001-5829-3553, Valter, Markus, Roth, Bernhard and Kribs, Angela (2016). Survival Among Infants Born at 22 or 23 Weeks' Gestation Following Active Prenatal and Postnatal Care. JAMA Pediatr., 170 (7). S. 671 - 678. CHICAGO: AMER MEDICAL ASSOC. ISSN 2168-6211

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Abstract

IMPORTANCE Rates of survival for infants born at the border of viability are still low and vary considerably among neonatal intensive care units. OBJECTIVE To determine whether higher survival rates and better short-term outcomes for infants born at 22 or 23 weeks' gestation may be achieved by active prenatal and postnatal care. DESIGN, SETTING, AND PARTICIPANTS Retrospective study of 106 infants born at 22 or 23 weeks of gestation at a level III neonatal intensive care unit at the University of Cologne Medical Centre in Cologne, Germany, between January 1, 2010, and December 31, 2014. Data analysis was performed in June 2015. EXPOSURES Active prenatal and postnatal care. MAIN OUTCOMES AND MEASURES Survival until hospital discharge and survival without neonatal or short-term severe complications (defined as high-grade intraventricular hemorrhage, surgery for abdominal complications, bronchopulmonary dysplasia, or retinopathy of prematurity). RESULTS Of 106 liveborn infants (45 born at 22 weeks and 61 born at 23 weeks and 6 days), 20 (19%) received palliative care (17 born at 22 weeks and 3 born at 23 weeks), and 86 (81%) received active care (28 born at 22 weeks and 58 born at 23 weeks). Of the 86 infants who received active care (mean [SD] maternal age, 32 [6] years), 58 (67%) survived until hospital discharge (17 born at 22 weeks and 41 born at 23 weeks). Eighty-five infants survived without severe complications, with 1 infant born at 22 weeks excluded because of missing data (6 of 27 [22%] born at 22 weeks, and 16 of 58 [28%] born at 23 weeks). Survival was predicted by the Apgar score after 5 minutes (odds ratio, 0.62 [95% CI, 0.46-0.84]) and birth weight (odds ratio, 0.001 [95% CI, 0.00-0.40]). CONCLUSIONS AND RELEVANCE One in 4 infants born at the border of viability and offered active care survived without severe complications. This finding should be considered for individualized parental approaches and decision making. Active follow-up information is required to determine childhood outcomes.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Mehler, Katrin UNSPECIFIED UNSPECIFIED UNSPECIFIED Oberthuer, Andre UNSPECIFIED UNSPECIFIED UNSPECIFIED Keller, Titus UNSPECIFIED UNSPECIFIED UNSPECIFIED Becker, Ingrid UNSPECIFIED orcid.org/0000-0001-5829-3553 UNSPECIFIED Valter, Markus UNSPECIFIED UNSPECIFIED UNSPECIFIED Roth, Bernhard UNSPECIFIED UNSPECIFIED UNSPECIFIED Kribs, Angela UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-270937
DOI:	10.1001/jamapediatrics.2016.0207
Journal or Publication Title:	JAMA Pediatr.
Volume:	170
Number:	7
Page Range:	S. 671 - 678
Date:	2016
Publisher:	AMER MEDICAL ASSOC
Place of Publication:	CHICAGO
ISSN:	2168-6211
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language EXTREMELY PRETERM INFANTS; BRONCHOPULMONARY DYSPLASIA; EXTREME PREMATURITY; OUTCOMES; SURFACTANT; VIABILITY; AGE; MORBIDITY; NEWBORNS Multiple languages Pediatrics Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/27093