Survival in infants live born at less than 24 weeks' gestation: The hidden morbidity of non-survivors

Abstract

Background: Although survival rates for infants of less than 26 weeks' gestation have increased, rates for those born at less than 24 weeks do not appear to have changed. While there are good data on overall survival, it is unclear how many infants are offered active resuscitation but do not survive. The study objectives were to describe the numbers receiving active treatment and the length of survival in infants live born at 22 or 23 weeks' gestation but who did not survive, and any changes over the last 15 years. Methods: The authors used a well-validated population-based database to identify deaths among live born infants born at 22 or 23 weeks' completed gestation between 1993 and 2007 from a single region in the north of England. The study period was divided into three 5-year cohorts. Survivors were identified from regional databases and individual case notes reviewed. Results: During the study period, there were 480 662 total live births, of which 229 were live born at 22-23 weeks' gestation (birth prevalence of 0.05%). Of the 210 infants who did not survive, 71 (34%) survived for longer than 6 h. The median survival of those who died but had received active resuscitation and were still alive at 6 h of age was 11 h in 1993-1997 (n=17), 20 h in 1998-2002 (n=28) and 3.7 days (n=26) in 2003-2007. Conclusion: Over the last 15 years, increasing numbers of babies <24 weeks received active resuscitation. Overall survival has not changed, but non-survivors endured significantly longer durations of intensive care.