title: A Proactive Approach to Neonates Born at 23 Weeks of Gestation.
abstract: OBJECTIVE
  To evaluate in-hospital survival, survival without major morbidity, and neurodevelopmental impairment for neonates born at 23 weeks of gestation provided proactive, coordinated, and comprehensive perinatal and neonatal management.
  
  
  METHODS
  This was a retrospective cohort study conducted at a single, tertiary care center between 2004 and 2013. Enrollment was limited to mother-neonate dyads at 23 weeks of gestation who were provided a proactive approach defined as documented evidence of antenatal corticosteroid administration, willingness to provide cesarean delivery for fetal distress, and neonatal resuscitation and intensive care. Among survivors, major morbidities (predischarge) and neurodevelopmental assessments at corrected ages of 18-22 months were examined.
  
  
  RESULTS
  Among 152 live births identified, 101 neonates received proactive care, of whom 60 (59%) survived to hospital discharge. Preterm premature rupture of membranes (adjusted odds ratio [OR] 0.29, 95% confidence interval [CI] 0.09-0.94), fetal growth restriction (OR 0.16, 95% CI 0.03-0.89), delivery room cardiopulmonary resuscitation (OR 0.07, 95% CI 0.02-0.32), and prolonged intubation sequence (OR 0.15, 95% CI 0.05-0.45) were associated with lower neonatal survival. Among neonatal intensive care unit survivors, 62% had at least one major morbidity. Among 50 survivors with assessment at 18-22 months, six (12%) were unimpaired, 20 (40%) had mild impairment, and 24 (48%) had moderate or severe neurodevelopmental impairment.
  
  
  CONCLUSIONS
  Proactive, interdisciplinary care enabled more than half of the neonates born at 23 weeks of gestation to survive, and approximately half of children evaluated at 18 months exhibited no or mild impairment. This information should be considered when providing prognostic advice to families with threatened preterm birth at 23 weeks of gestation.
  
  
  METHODS
  II.
authors.affiliation: Departments of Pediatrics and Obstetrics & Gynecology, The Ohio State University Wexner Medical Center, and the Center for Perinatal Research, the Heart Center, the Department of Pediatrics, and the Biostatistics Core, Nationwide Children's Hospital, Columbus, Ohio; and the Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Carl H
authors.initials: CH
authors.lastname: Backes
authors.forename: Brian K
authors.initials: BK
authors.lastname: Rivera
authors.forename: Urbee
authors.initials: U
authors.lastname: Haque
authors.forename: Lara
authors.initials: L
authors.lastname: Srouji
authors.forename: Stacy
authors.initials: S
authors.lastname: Beck
authors.forename: Han
authors.initials: H
authors.lastname: Yin
authors.forename: Charles V
authors.initials: CV
authors.lastname: Smith
authors.forename: Jay D
authors.initials: JD
authors.lastname: Iams
authors.forename: Leif D
authors.initials: LD
authors.lastname: Nelin
mesh_terms: D000328:Adult; D005260:Female; D005865:Gestational Age; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D065886:Neurodevelopmental Disorders / Q000453:epidemiology*; D009820:Ohio / Q000453:epidemiology; D018743:Perinatal Care; D011247:Pregnancy; D012189:Retrospective Studies; D055815:Young Adult