Medial Publications about Survival of 22 week neonates
Links to medical studies, reports and treatments for babies born at 22 weeks of gestation and survival.
Authors: Dagle, J. M., Rysavy, M. A., Hunter, S. K., Colaizy, T. T., Elgin, T. G., Giesinger, R. E., McElroy, S. J., Harmon, H. M., Klein, J. M., McNamara, P. J., & Segar, J. L.
Publication: Seminars in Perinatology
DOI: 10.1016/j.semperi.2021.151545
Date: Feb 2022
The approach to clinical care of infants born at 22 weeks' gestation must be consistent and well-designed if optimal results are to be expected. Publications from several international centers have demonstrated that, although there may be variance in aspects of care in this vulnerable population, treatment should be neither random nor inconsistent. In designing a standardized approach, careful attention should be paid to the unique anatomy, physiology, and biochemistry of this vulnerable patient population. Emerging evidence, suggesting a link between cardiopulmonary health and longer-term sequela, highlights the importance of understanding the relationship between cardiorespiratory illnesses of the 22-week infant, treatments provided, and subsequent cardiopulmonary development. In this review we will provide an overview to our approach to cardiopulmonary assessment and treatment, with a particular emphasis on the importance of early recognition of atypical phenotypes, timely interventions with evidence-based treatments, and longitudinal monitoring.
Authors: Lee, C. D., Nelin, L., & Foglia, E. E. (2022).
Publication:The New England Journal of Medicine, 386(4), 391-393. https://doi.org/10.1056/NEJMclde2114954
Date:Jan 27, 2022
Neonatal ResuscitationThis interactive feature about infants born very prematurely offers a case vignette accompanied by two essays supporting resuscitation in all neonates born at 22 weeks’ gestation or selective resuscitation. Vote and comment at NEJM.org.
"It is important to note that delaying delivery as long as it is safe for the mother and the fetus is the preferred approach. Now let us consider the question of resuscitation in all infants. After all, wouldn’t it be easier to take a case-by-case approach? The answer is an emphatic “no.” First, a standard approach to neonatal resuscitation and early post-resuscitative care, within the so-called golden hour, is well accepted to improve outcomes.1 Second, these decisions are often made quickly, as in this vignette. Having a truly informed discussion is difficult given the stressors involved and the need to focus on the mother’s medical care as well. Third, prenatal gestational age assessments are suboptimal, which makes it difficult to be certain of a fetus’s exact gestational age.2 Fourth, a case-by-case approach allows for implicit biases to potentially influence decisions and contribute to the well-documented disparities in infant mortality in the United States.
Data have been published that support the use of a standard approach to resuscitating the neonates in all deliveries at 22 weeks’ gestation. For example, in a study by Backes et al., the mortality rate at a hospital that used selective resuscitation was worse than the rate at a hospital in which active care was provided to all infants (survival, 19% vs. 53%, P<0.05).3 A report from a hospital in Iowa in which active resuscitation was offered for all infants born at 22 to 23 weeks’ gestation showed that 70% of the infants born at 22 weeks survived and 55% of these patients had no or only mild neurodevelopmental impairment at follow-up.4 A cohort study of Swedish infants born at 22 to 24 weeks’ gestation showed that 52% of the infants born at 22 weeks’ gestation survived, with 50% of the survivors having no neurodevelopmental impairment at 2.5 years of age, outcomes that mirrored those in infants born at 23 to 24 weeks.5"
Author: Norman, Mikael; Hallberg, Boubou
Publication: JAMA
Publisher: American Medical Association
Date: Mar 26, 2019
In this comparison of 2 birth cohorts in Sweden that included 2205 births at 22-26 weeks’ gestational age, 1-year survival among those born alive in 2004-2007 was 70% compared with 77% for those born alive in 2014-2016 and the difference was statistically significant.
"Systematic survival among infants at 22 weeks’ gestational age has not been restricted to Swedish hospitals. For example, the Japanese Neonatal Network (including tertiary centers only) reported a survival rate of 36% among live-born infants at 22 weeks’ gestational age during 2003-2005.31 Researchers at the University of Iowa Hospitals and Clinics reported a survival rate of 33% among infants born without any major congenital anomalies at 22 weeks’ gestational age during 2000-2009,32 and the University of Cologne (in Germany) reported a survival rate of 67% to hospital discharge among infants born at 22-23 weeks’ gestational age receiving active care (instead of only comfort care) during 2010-2014.33 At 24 US hospitals, the survival rate was 23% among infants born at 22 weeks’ gestational age if active care was offered.1 A study of US tertiary centers reported a survival rate of 28% at 22 weeks’ gestation when infants were resuscitated, which increased to 38% in the subgroup that also received antenatal corticosteroids.34"
Backes, C.H., Söderström, F., Ågren, J. et al. .Journal of Perinatology volume 39, pages39–47(2019) doi:10.1038/s41372-018-0248-y Published: 23 October 2018
One center (Uppsala, Sweden; UUCH) provided proactive care to all mother–infant dyads (comprehensive center); the other center (Nationwide Children’s Hospital, USA; NCH) initiated or withheld treatment based on physician and family preferences (selective center). Differences in outcomes between the two centers were evaluated.
Result
Among 112 live-born infants at 22 weeks of gestation, those treated at UUCH had in-hospital survival rates higher than those at NCH (21/40, 53% vs. 6/72, 8%; P < 0.01).
Click here to read a Canadian Neonatologist blog post of this study
May 7, 2015
N Engl J Med 2015; 372:1801-1811
DOI: 10.1056/NEJMoa1410689
Overall rates of survival and survival without severe impairment ranged from 5.1% (IQR, 0 to 10.6) and 3.4% (IQR, 0 to 6.9), respectively, among children born at 22 weeks of gestation... (please note these rates are listed as ones with out server impairment like ROP, BPD etc. Click here for more about these definitions used in studies)
Raju, T., Mercer, B., Burchfield, D. et al.
Journal of Perinatology volume 34, pages333–342(2014)
When counseling parents, it is appropriate to present the data regarding the rate of survival and long-term disabilities separately, as the parents’ perspectives and the importance they give these may be different. Physicians should recognize that the parents’ views on what is a ‘severe’ disability may be different from those of the researchers or clinicians, who traditionally report the combination of death and severe disability together. Coping with a child’s behavior problem, considered a ‘minor’ disability in the published literature, may be difficult to handle for some families, while other families may be able to adapt more readily to disabilities typically considered to be major (for example, cerebral palsy).
Abstract
Our aim was to evaluate the literature on survival and major disability rate in preterm infants born at 22- 25 weeks of gestational age (GA).
We compared survival and neurodevelopmental outcomes among infants born at 22 to 24 weeks of gestation, as assessed at 18 to 22 months of corrected age, across three consecutive birth-year epochs (2000–2003 [epoch 1], 2004–2007 [epoch 2], and 2008–2011 [epoch 3]).
PEDIATRICS Volume 138 , number 1 , July 2016 :e 20154434
WHAT’S KNOWN ON THIS SUBJECT: Extremely preterm infants (22–28 weeks’ gestation) are at high risk of death and morbidity. In recent years, more infants born at 22 to 24 weeks’ gestation are being resuscitated instead of receiving comfort care only.
WHAT THIS STUDY ADDS: In our population-based study, extremely preterm infants remain at risk for death and major morbidity, with 22- to 25-week gestation infants being at highest risk. We report rates of resuscitation and timing of death for 22- to 28-week gestation infants.
Author: Norman, Mikael; Hallberg, Boubou
Publication: JAMA
Publisher: American Medical Association
Date: Mar 26, 2019
In this comparison of 2 birth cohorts in Sweden that included 2205 births at 22-26 weeks’ gestational age, 1-year survival among those born alive in 2004-2007 was 70% compared with 77% for those born alive in 2014-2016 and the difference was statistically significant.
"Systematic survival among infants at 22 weeks’ gestational age has not been restricted to Swedish hospitals. For example, the Japanese Neonatal Network (including tertiary centers only) reported a survival rate of 36% among live-born infants at 22 weeks’ gestational age during 2003-2005.31 Researchers at the University of Iowa Hospitals and Clinics reported a survival rate of 33% among infants born without any major congenital anomalies at 22 weeks’ gestational age during 2000-2009,32 and the University of Cologne (in Germany) reported a survival rate of 67% to hospital discharge among infants born at 22-23 weeks’ gestational age receiving active care (instead of only comfort care) during 2010-2014.33 At 24 US hospitals, the survival rate was 23% among infants born at 22 weeks’ gestational age if active care was offered.1 A study of US tertiary centers reported a survival rate of 28% at 22 weeks’ gestation when infants were resuscitated, which increased to 38% in the subgroup that also received antenatal corticosteroids.34"