PT  - JOURNAL ARTICLE
AU  - Ishii, Nozomi
AU  - Kono, Yumi
AU  - Yonemoto, Naohiro
AU  - Kusuda, Satoshi
AU  - Fujimura, Masanori
AU  - , 
TI  - Outcomes of Infants Born at 22 and 23 Weeks’ Gestation
AID  - 10.1542/peds.2012-2857
DP  - 2013 Jul 01
TA  - Pediatrics
PG  - 62--71
VI  - 132
IP  - 1
4099  - http://pediatrics.aappublications.org/content/132/1/62.short
4100  - http://pediatrics.aappublications.org/content/132/1/62.full
SO  - Pediatrics2013 Jul 01; 132
AB  - OBJECTIVE: To provide instructive information on death and neurodevelopmental outcomes of infants born at 22 and 23 weeks’ gestational age.METHODS: The study cohort consisted of 1057 infants born at 22 to 25 weeks in the Neonatal Research Network, Japan. Neurodevelopmental impairment (NDI) at 36 to 42 months’ chronological age was defined as any of the following: cerebral palsy, hearing impairment, visual impairment, and a developmental quotient <70. A systematic review was performed by using databases of publications of cohort studies with neonatal and neurodevelopmental outcomes at 22 and 23 weeks.RESULTS: Numbers and incidences (%) of infants with death or NDI were 60 (80%) at 22 weeks and 156 (64%) at 23 weeks. In logistic regression analysis, gestational ages of 22 weeks (odds ratio [OR]: 5.40; 95% confidence interval [CI]: 2.48–11.76) and 23 weeks (OR: 2.14; 95% CI: 1.38–3.32) were associated with increased risk of death or NDI compared with 24 weeks, but a gestational age of 25 weeks (OR: 0.65; 95% CI: 0.45–0.95) was associated with decreased risk of death or NDI. In the systematic review, the medians (range) of the incidence of death or NDI in 8 cohorts were 99% (90%–100%) at 22 weeks and 98% (67%–100%) at 23 weeks.CONCLUSIONS: Infants born at 22 and 23 weeks’ gestation were at higher risk of death or NDI than infants at born at 24 weeks. However, outcomes were improved compared with those in previous studies. There is a need for additional discussions on interventions for infants born at 22 or 23 weeks’ gestation.Abbreviations:CI — confidence intervalCLD — chronic lung diseaseCP — cerebral palsyDQ — developmental quotientGMFCS — Gross Motor Function Classification SystemIVH — intraventricular hemorrhageKSPD — Kyoto Scale of Psychological DevelopmentNDI — neurodevelopmental impairmentOR — odds ratioROP — retinopathy of prematurity