Five-year survival without major disability of extremely preterm infants born at 22-27 weeks' gestation admitted to a NICU.
OBJECTIVE
To compare the 5-year survival without major disability in infants born at the threshold of viability at 22-25 weeks who were actively treated in the delivery room and admitted to a NICU to that of those born at 26-27 weeks of gestation.


METHODS
All infants between 22(+0) and 27(+6) weeks of gestation admitted to a regional intensive care unit during 1999-2003 were enrolled prospectively. The survival and major disability at 5 years of age were analysed by gestational age.


RESULTS
Of 242 treated infants, 202 survived (83.5%). Although the overall survival rate was significantly higher in the 25-27 weeks' gestation infants than the 22-24 weeks' gestation infants (p < 0.001), the survival rate among infants 22-24 weeks (63.6%, 63.6%, and 70%) did not significantly differ, likewise infants 25-27 weeks (88.7%, 90.6%, and 92%) had similar results. Overall, 28 children (14.4% of assessed) had major disability. Both survival and survival without major disability were positively influenced by increasing gestational age, increasing birth weight, being born at 25-27 weeks and being female child.


CONCLUSIONS
With an active approach in treatment, the outcome of infants born at 25 weeks is comparable to those born at 26-27 weeks. Thus, the 'grey zone' in which the risk of adverse outcome is high narrows to 22-24 weeks.
Division of Neonatology, Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University in Prague, Prague, Czech Republic. b.zlatohlavkova@seznam.cz
B
B
Zlatohlávková
J
J
Kytnarová
Aa
A
Kuběna
A
A
Fleischnerová
M
M
Dokoupilová
R
R
Plavka
D017677:Age Distribution; D046688:Child Mortality; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D011446:Prospective Studies; D015996:Survival Rate