RT Journal Article
SR Electronic
T1 Outcomes of Infants Born at 22 and 23 Weeks’ Gestation
JF Pediatrics
JO Pediatrics
FD American Academy of Pediatrics
SP 62
OP 71
DO 10.1542/peds.2012-2857
VO 132
IS 1
A1 Ishii, Nozomi
A1 Kono, Yumi
A1 Yonemoto, Naohiro
A1 Kusuda, Satoshi
A1 Fujimura, Masanori
A1 ,
YR 2013
UL http://pediatrics.aappublications.org/content/132/1/62.abstract
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