Mortality Predictive Risk Factors of Limits-Of-Viability Preterm Infants at 23 And 24 Weeks Gestation

Abstract

Husam Salama, Hilal Al. Rifai, Nazla Mahmoud, Ismail Sabry, Amr Mousa, Olfa Ben Hadj Khalifa, Sawsan Al.Obiadly, Mai Al.Qubasi, and Amal Sabouny

Objective: The purpose of this study was to examine perinatal and postnatal events associated with neonatal mortality among 23 and 24 weeks gestation preterm infants.

Methods: A population-based retrospective study of infants born at 23 and 24 weeks gestational age over a two-andhalf- year period.

Results: A hundred and five preterm infants were investigated during the period of the study: 60 infants born at 23 weeks gestation and 45 infants born at 24 weeks gestation. In total, 79 infants were admitted to the NICU (75%). Twenty-six infants died in the delivery room. Twenty-six infants died within the first two weeks of life (33%) and 12 died beyond the first two weeks of life (15%). The survival rates for infants admitted to the NICU were 35% and 66% for 23 and 24 weeks infants, respectively. Altogether, 41 of all NICU-admitted infants remained alive until discharge (52%). (Figure 1) The majority of deaths occurred during the first two weeks of life (26/38; 68%).Tthe most associated risk factors were a lack of antenatal steroid ( p value < .001), bruises (0.002), gelatinous skin (0.032), and IVH (0.03) . Severe respiratory failure was the main cause of death. Failure to extubate from a respirator by two weeks of age with an FIO2 requirement > 50% was the main risk factor associated with death beyond two weeks of life (OR > 10.0 and p value of< 0.001).In comparison to mothers who did not receive antenatal steroids, an incomplete course showed a significant but lower risk of mortality (OR=3 vs. 13 and P value 0.001 vs 0.3). The rate of ANS administration approached 90% in 24 weeks gestation age vs 53% in the 23 weeks age group. The tendency to perform CS was < 10% in 23 weeks and up to 28 % in 24 weeks. Attending neonatologists decided to offer resuscitation in 93 % of 24 weeks versus 65% of 23 weeks newborn.

Conclusions: Antenatal steroids, the degree of immaturity, a birth weight less than 750 grams, and need for IPPV ventilation while requiring more than 50% FIO2 at two weeks of age were the circumstances most associated with death. The survival rates until discharge for 23 and 24 weeks gestational age infants were 35% and 66%. Resuscitation selection criteria for 23 weeks gestation would provide a reasonable platform for forming an approach towards this particular gestational age.

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