title: Neonatal outcome after active perinatal management of the very premature infant between 23 and 27 weeks' gestation.
abstract: OBJECTIVE
  To record the effect of aggressive perinatal management on neonatal outcome in the very premature infant.
  
  
  METHODS
  A retrospective chart review of 114 infants born between 23 and 27 weeks' gestation, managed by one perinatal transport service at one hospital between July 1989 and December 1993. Fetuses > 23 weeks' gestation were considered viable and were managed with tocolytics, antibiotics, and surfactant at the discretion of the treating physician. Morbidity and mortality rates in the first 6 months, including stillbirths were analyzed. A major neurologic condition was defined as ultrasonographic evidence of grade 3 or 4 intraventricular hemorrhage or periventricular leukomalacia.
  
  
  RESULTS
  Both neonatal mortality rate and the incidence of stillbirths decreased with advancing gestational age. Of 24 infants born at 23 weeks' gestation, 33% were stillborn and 13% were alive at 6 months. This survival rate improved to 48% for infants delivered at 24 weeks' gestation, and to 68%, 75%, and 71% for those delivered at 25, 26, and 27 weeks' gestation, respectively. The percentage of infants who survived without a major neurologic condition increased with advancing gestational age at delivery from 13% at 23 weeks' gestation to 40% at 24 weeks, 48% at 25 weeks, 70% at 26 weeks, and 71% at 27 weeks. The incidence of retinitis of prematurity, respiratory complications, and days spent in the hospital decreased with greater gestational age.
  
  
  CONCLUSIONS
  An active plan of management for all gestations of > 23.9 weeks seems appropriate.
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: W B
authors.initials: WB
authors.lastname: Kramer
authors.forename: G R
authors.initials: GR
authors.lastname: Saade
authors.forename: L
authors.initials: L
authors.lastname: Goodrum
authors.forename: L
authors.initials: L
authors.lastname: Montgomery
authors.forename: M
authors.initials: M
authors.lastname: Belfort
authors.forename: K J
authors.initials: KJ
authors.lastname: Moise
mesh_terms: D000293:Adolescent; D000328:Adult; D004453:Echoencephalography; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy; D007902:Length of Stay; D017283:Neonatal Nursing / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011262:Pregnancy Trimester, Second; D012189:Retrospective Studies; D016896:Treatment Outcome