Download PDF
Am J Perinatol 2024; 41(05): 660-668
DOI: 10.1055/a-1779-4032
Original Article

Prognosis of 22- and 23-Gestational-Week-Old Infants at Our Facility: A Retrospective Cohort Study

Toshimitsu Yanagisawa 
1   Division of Neonatology, Nagano Children's Hospital, Azumino, Nagano, Japan
,
Tomohiko Nakamura
1   Division of Neonatology, Nagano Children's Hospital, Azumino, Nagano, Japan
2   Division of Neonatology, Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
,
Masayo Kokubo
1   Division of Neonatology, Nagano Children's Hospital, Azumino, Nagano, Japan
3   Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan
› Author Affiliations Funding None.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective This study aimed to compare inborn infants aged 22 and 23 gestational weeks at our hospital to assess for differences in survival and long-term prognosis.

Study Design We retrospectively analyzed 22- and 23-gestational-weeks-old infants born in our hospital between January 2011 and December 2018. The prognosis of inborn infants in Japan was also calculated using the Neonatal Research Network of Japan (NRNJ) data during the same period.

Results The survival rates at our institution's neonatal intensive care unit discharge, including stillbirth, were 72 and 89% at 22 and 23 gestational weeks, respectively. The mortality rate and neurodevelopmental impairment (NDI) rate at 3 years of age, including stillbirth, were 58 and 32% at 22 and 23 weeks, respectively. Cerebral palsy, mental developmental retardation, visual impairment, and hearing impairment defined NDI. The prognosis at our hospital was better than the average calculated using NRNJ data. Survival rates varied among facilities, and some facilities had survival rates similar to that of our hospital.

Conclusion The prognosis of 22-gestational-week-old inborn infants was inferior to that of 23 gestational weeks in our institution but was better than previously reported. If aggressive treatment is provided, survival without sequelae can be fully expected even for 22-gestational-week-old infants.

Key Points

  • We examined babies of gestation ages 22 and 23 weeks.

  • We examined the survival and neurological prognoses.

  • We compared our facility with that in entire Japan.

Keywords

extremely low birth weight - infant - mortality rate - neurodevelopmental outcome - survival rate

Authors' Contribution

T.Y. and T.N. conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. M.K. revised the manuscript. All authors approved the final manuscript and agree to be accountable for all aspects of the work.


Supplementary Material



Publication History

Received: 13 October 2021

Accepted: 07 February 2022

Accepted Manuscript online:
22 February 2022

Article published online:
11 March 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Kusuda S, Fujimura M, Uchiyama A, Totsu S, Matsunami K. Neonatal Research Network, Japan. Trends in morbidity and mortality among very-low-birth-weight infants from 2003 to 2008 in Japan. Pediatr Res 2012; 72 (05) 531-538
    CrossrefPubMedGoogle Scholar
  • 2 Ishii N, Kono Y, Yonemoto N, Kusuda S, Fujimura M. Neonatal Research Network, Japan. Outcomes of infants born at 22 and 23 weeks' gestation. Pediatrics 2013; 132 (01) 62-71
    CrossrefPubMedGoogle Scholar
  • 3 Lui K, Lee SK, Kusuda S. et al; International Network for Evaluation of Outcomes (iNeo) of neonates Investigators. Trends in outcomes for neonates born very preterm and very low birth weight in 11 high-income countries. J Pediatr 2019; 215: 32-40.e14
    CrossrefPubMedGoogle Scholar
  • 4 Itabashi K, Horiuchi T, Kusuda S. et al. Mortality rates for extremely low birth weight infants born in Japan in 2005. Pediatrics 2009; 123 (02) 445-450
    CrossrefPubMedGoogle Scholar
  • 5 Kono Y, Yonemoto N, Nakanishi H, Kusuda S, Fujimura M. Changes in survival and neurodevelopmental outcomes of infants born at <25 weeks' gestation: a retrospective observational study in tertiary centres in Japan. BMJ Paediatr Open 2018; 2 (01) e000211
    CrossrefPubMedGoogle Scholar
  • 6 Isayama T. The clinical management and outcomes of extremely preterm infants in Japan: past, present, and future. Transl Pediatr 2019; 8 (03) 199-211
    CrossrefPubMedGoogle Scholar
  • 7 Hosono S, Ohno T, Kimoto H, Shimizu M, Harada K. Morbidity and mortality of infants born at the threshold of viability: ten years' experience in a single neonatal intensive care unit, 1991-2000. Pediatr Int 2006; 48 (01) 33-39
    CrossrefPubMedGoogle Scholar
  • 8 Costeloe KL, Hennessy EM, Haider S, Stacey F, Marlow N, Draper ES. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ 2012; 345: e7976
    CrossrefPubMedGoogle Scholar
  • 9 Ecker JL, Kaimal A, Mercer BM. et al; American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine. Periviable birth: Interim update. Am J Obstet Gynecol 2016; 215 (02) B2-B12, 12.e1
    CrossrefPubMedGoogle Scholar
  • 10 Doyle LW, Roberts G, Anderson PJ. Victorian Infant Collaborative Study Group. Outcomes at age 2 years of infants < 28 weeks' gestational age born in Victoria in 2005. J Pediatr 2010; 156 (01) 49-53.e1
    CrossrefPubMedGoogle Scholar
  • 11 Stoll BJ, Hansen NI, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (03) 443-456
    CrossrefPubMedGoogle Scholar
  • 12 Guillén Ú, Weiss EM, Munson D. et al. Guidelines for the management of extremely premature deliveries: a systematic review. Pediatrics 2015; 136 (02) 343-350
    CrossrefPubMedGoogle Scholar
  • 13 Rysavy MA, Li L, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med 2015; 372 (19) 1801-1811
    CrossrefPubMedGoogle Scholar
  • 14 Sugiura T, Kouwaki M, Togawa Y, Sugimoto M, Togawa T, Koyama N. Neurodevelopmental outcomes at 18 months' corrected age of infants born at 22 weeks of gestation. Neonatology 2011; 100 (03) 228-232
    CrossrefPubMedGoogle Scholar
  • 15 Younge N, Goldstein RF, Bann CM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Survival and neurodevelopmental outcomes among periviable infants. N Engl J Med 2017; 376 (07) 617-628
    CrossrefPubMedGoogle Scholar
  • 16 Smith LK, Morisaki N, Morken NH. et al. An international comparison of death classification at 22 to 25 weeks' gestational age. Pediatrics 2018; 142 (01) e20173324
    CrossrefPubMedGoogle Scholar
  • 17 Hirata K, Kimura T, Hirano S, Wada K, Kusuda S, Fujimura M. Neonatal Research Network of Japan. Outcomes of outborn very-low-birth-weight infants in Japan. Arch Dis Child Fetal Neonatal Ed 2021; 106 (02) 131-136
    CrossrefPubMedGoogle Scholar
  • 18 Society for the Kyoto Scale of Psychological Development Test, Shinpan K Shiki hattatsu Kensahou 2001. Nenban [the Kyoto Scale of Psychological Development Test 2001] Kyoto, Japan: Nakanishiya Shuppan; 2008 (in Japanese)
    PubMed
  • 19 Itabashi K, Miura F, Uehara R, Nakamura Y. New Japanese neonatal anthropometric charts for gestational age at birth. Pediatr Int 2014; 56 (05) 702-708
    CrossrefPubMedGoogle Scholar
  • 20 Moore T, Hennessy EM, Myles J. et al. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ 2012; 345: e7961
    CrossrefPubMedGoogle Scholar
  • 21 Serenius F, Källén K, Blennow M. et al; EXPRESS Group. Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden. JAMA 2013; 309 (17) 1810-1820
    CrossrefPubMedGoogle Scholar
  • 22 Mehler K, Oberthuer A, Keller T. et al. Survival among infants born at 22 or 23 weeks' gestation following active prenatal and postnatal care. JAMA Pediatr 2016; 170 (07) 671-677
    CrossrefPubMedGoogle Scholar
  • 23 Batton DG. Committee on Fetus and Newborn. Clinical report–Antenatal counseling regarding resuscitation at an extremely low gestational age. Pediatrics 2009; 124 (01) 422-427
    CrossrefPubMedGoogle Scholar
  • 24 Lemyre B, Moore G. Counselling and management for anticipated extremely preterm birth. Paediatr Child Health 2017; 22 (06) 334-341
    CrossrefPubMedGoogle Scholar
  • 25 Kaempf JW, Tomlinson MW, Campbell B, Ferguson L, Stewart VT. Counseling pregnant women who may deliver extremely premature infants: medical care guidelines, family choices, and neonatal outcomes. Pediatrics 2009; 123 (06) 1509-1515
    CrossrefPubMedGoogle Scholar
  • 26 Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. Neurologic and developmental disability after extremely preterm birth. EPICure Study Group. N Engl J Med 2000; 343 (06) 378-384
    CrossrefPubMedGoogle Scholar
  • 27 Raju TNK, Mercer BM, Burchfield DJ, Joseph Jr GF. Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. Am J Obstet Gynecol 2014; 210 (05) 406-417
    CrossrefPubMedGoogle Scholar
  • 28 Evans DJ, Levene MI. Evidence of selection bias in preterm survival studies: a systematic review. Arch Dis Child Fetal Neonatal Ed 2001; 84 (02) F79-F84
    CrossrefPubMedGoogle Scholar
  • 29 Weber C, Weninger M, Klebermass K. et al. Mortality and morbidity in extremely preterm infants (22 to 26 weeks of gestation): Austria 1999-2001. Wien Klin Wochenschr 2005; 117 (21-22): 740-746
    CrossrefPubMedGoogle Scholar
  • 30 Vohr BR, Stephens BE, Higgins RD. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Are outcomes of extremely preterm infants improving? Impact of Bayley assessment on outcomes. J Pediatr 2012; 161 (02) 222-8.e3
    CrossrefPubMedGoogle Scholar
  • 31 Kono Y, Yonemoto N, Kusuda S. et al. Developmental assessment of VLBW infants at 18 months of age: a comparison study between KSPD and Bayley III. Brain Dev 2016; 38 (04) 377-385
    CrossrefPubMedGoogle Scholar
  • 32 Anderson GD, Bada HS, Shaver DC. et al. The effect of cesarean section on intraventricular hemorrhage in the preterm infant. Am J Obstet Gynecol 1992; 166 (04) 1091-1099 , discussion 1099–1101
    CrossrefPubMedGoogle Scholar
  • 33 Jarde A, Feng YY, Viaje KA, Shah PS, McDonald SD. Vaginal birth vs caesarean section for extremely preterm vertex infants: a systematic review and meta-analyses. Arch Gynecol Obstet 2020; 301 (02) 447-458
    CrossrefPubMedGoogle Scholar
  • 34 David M, Halle H, Lichtenegger W, Sinha P, Zimmermann T. Nitroglycerin to facilitate fetal extraction during cesarean delivery. Obstet Gynecol 1998; 91 (01) 119-124
    CrossrefPubMedGoogle Scholar
  • 35 Lin CH, Lin SY, Yang YH. et al. Extremely preterm cesarean delivery “en caul”. Taiwan J Obstet Gynecol 2010; 49 (03) 254-259
    CrossrefPubMedGoogle Scholar
  • 36 Mercier CE, Dunn MS, Ferrelli KR, Howard DB, Soll RF. Vermont Oxford Network ELBW Infant Follow-Up Study Group. Neurodevelopmental outcome of extremely low birth weight infants from the Vermont Oxford network: 1998-2003. Neonatology 2010; 97 (04) 329-338
    CrossrefPubMedGoogle Scholar