title: Morbidity and mortality of preterm infants less than 26 weeks of gestational age.
abstract: BACKGROUND
  Extreme preterm infants have a high risk of morbidity and mortality. Newborns delivered between 23+0 and 25+6 weeks, are considered to be in the "gray zone" and have uncertain prognosis. For these children medical decision-making becomes complex and controversial. The present study intends to evaluate the neonatal morbidity and mortality of preterm infants born between 23 weeks and 25+6 weeks of gestational age.
  
  
  METHODS
  A retrospective study was conducted including all inborn preterm infants, with a gestational age between 23+0 and 25+6 weeks, admitted to a level IIIC NICU, between January 1st, 1996 and December 31st, 2014.
  
  
  RESULTS
  A total of 72 preterm neonates were included, 18.1% had a full cycle of antenatal steroids. The most frequent major morbidities were RDS (95.4%), patent ductus arteriosus (81.3%), sepsis (55.7%, being 19.7% early sepsis, and 36.1% late sepsis), intraventricular hemorrhage (34.4%), retinopathy of prematurity (21.9%) and necrotizing enterocolitis (10.9%). Fifty-four (75%) children died. The only factor adjusted to age associated with high mortality founded was hypotension (OR=4.99, P<0.019). Morbidity at discharge was: severe bronchopulmonary dysplasia (77.8%), retinopathy of prematurity (72.2%), intraventricular hemorrhage (16.7%), cystic periventricular leukomalacia (11.1%), and sequalae of necrotizing enterocolitis (5.6%).
  
  
  CONCLUSIONS
  The survival rate was 25% and a high morbidity at discharge was observed, which leave us with the huge responsibility to improve this result in a near future. Extreme prematurity is still a very controversial and complex issue and particular challenge for neonatologists. The use of antenatal steroid in the more immature preterm infants should be encouraged.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Porto University, Porto, Portugal - mimed10158@med.up.pt.
authors.forename: Maria I
authors.initials: MI
authors.lastname: da Cunha Durães
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Porto University, Porto, Portugal.|Neonatal Intensive Care Unit, Department of Pediatrics, São João Hospital, Porto, Portugal.
authors.forename: Filipa
authors.initials: F
authors.lastname: Flor-De-Lima
authors.affiliation: Neonatal Intensive Care Unit, Department of Pediatrics, São João Hospital, Porto, Portugal.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Rocha
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Porto University, Porto, Portugal.|Neonatal Intensive Care Unit, Department of Pediatrics, São João Hospital, Porto, Portugal.
authors.forename: Henrique
authors.initials: H
authors.lastname: Soares
authors.affiliation: Neonatal Intensive Care Unit, Department of Pediatrics, São João Hospital, Porto, Portugal.
authors.forename: Hercília
authors.initials: H
authors.lastname: Guimarães
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D007363:Intensive Care Units, Neonatal; D008297:Male; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones