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Neonatal Outcome of Infants Born at 23 Weeks’ Gestation

From the Departments of Obstetrics, Gynecology and Reproductive Biology and Newborn Medicine, Brigham & Women’s Hospital, and Vincent Department of Obstetrics & Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

Address reprint requests to: Thomas F. McElrath, MD, PhD Department of Obstetrics, Gynecology and Reproductive Biology Brigham & Women’s Hospital 75 Francis Street Boston, MA 02115 E-mail: tmcelrath{at}partners.org

Objective: To determine the neonatal outcome in accurately dated 23-week deliveries.

Methods: We reviewed the records of consecutive births between 23 0/7 and 23 6/7 weeks at Brigham & Women’s Hospital, Boston, Massachusetts, from January 1995 to December 1999. Women were excluded if they presented for elective termination or had known fetal death or poor dating criteria. Neonatal records were abstracted for mortality and short-term morbidity, including the respiratory distress syndrome (RDS), intraventricular hemorrhage, chronic lung disease, necrotizing enterocolitis, periventricular leukomalacia, and retinopathy of prematurity. Survival was defined as discharge from neonatal intensive care.

Results: Thirty-three singleton pregnancies met criteria for inclusion, 11 of whom survived to discharge (survival rate 0.33; 95% CI 0.18, 0.52). More advanced gestational age was associated with increased likelihood of survival: 0 of 12 at 23 0/7 to 23 2/7 weeks, 4 of 10 at 23 3/7 to 23 4/7 weeks, and 7 of 11 at 23 5/7 to 23 6/7 weeks (P =.02). All 11 survivors developed RDS and chronic lung disease. One of 11 survivors had necrotizing enterocolitis, and 2 of 11 had severe retinopathy of prematurity. One survivor had periventricular leukomalacia on head ultrasonography, compared with 7 of the nonsurvivors who had head ultrasonography (P =.03). One survivor developed severe intraventricular hemorrhage (grade 3 or 4) compared with 8 of the 12 at-risk nonsurvivors who had head ultrasonography (P = .01).

Conclusion: About one third of infants delivered at 23 weeks’ gestation survived to be discharged from neonatal intensive care. More advanced gestational age was associated with increased likelihood of survival. No neonates survived free of substantial morbidity.

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