Hypotension, patent ductus arteriosus, pulmonary hypertension
Water and electrolyte imbalance, acid-base disturbances
Iatrogenic anemia, need for frequent transfusions, anemia of prematurity
Hypoglycemia, transiently low thyroxine levels, cortisol deficiency
Bronchopulmonary dysplasia, reactive airway disease, asthma
Failure to thrive, short-bowel syndrome, cholestasis
Respiratory syncytial virus infection, bronchiolitis
Cerebral palsy, hydrocephalus, cerebral atrophy, neurodevelopmental delay, hearing loss Blindness, retinal detachment, myopia, strabismus
Pulmonary hypertension, hypertension in adulthood
Impaired glucose regulation, increased insulin
Data from Eichenwald, 2008.
TABLE 42-3. Outcomes at 2V2 Years Corrected Age 80 by Gestational Age at Birth in Sweden, 2004-2007 )o 40 • Ishii (2013) .D • Stoll (2010) Outcome 22 23 24 25 26 Total o (no.)
Survived to 10 53 67 82 85 70
FIGURE 42-2 Neonatal survival rates according to condition at birth and gestational age. Ishii (201o3) data curve reflects liveborn survival rates; Stoll (201o0) curve reflects liveborn survival rates; Mild 40 19 33 29 34 31 Rysavy (2015) curve reflects overall survival rates. Moderate 20 30 21 17 10 16 • %of infants who died • %of infants who survived with he Obstetric Care Consensus summary provides a review of outcomes for those born in the periviable period. Delivery before 23 weeks typically results in death, and survival rates approximate only 5 percent (Fig. 42-2). Among those that live, morbidity is nearly universal. Notably, the authors highlight the wide variation in practices regarding active resuscitation and suggest that these variations may explain the difering perinatal outcomes among diferent institutions. An important caveat, however, is ascertainment bias. For example, the mean survival rate is 45 percent if the denominator is all live births compared with 72 percent if the denominator is only newborns admitted to neonatal intensive care (Guillen, 2011). Another source of bias is use of multicenter datasets with considerable diferences in obstetrical and early neonatal interventions, particularly at 22 and 23 weeks' gestation (Stoll, 2010).
To evaluate contemporaneous outcomes of neonates born at 22 to 24 weeks, the NICHD Neonatal Research Network reported both survival and neurodevelopmental outcomes assessed across consecutive birth-year epochs of 2000 to 2003, 2004 to 2007, and 2008 to 2011 in infants aged 18 to 22 months (Younge, 2017). The percentage of infants who survived rose signiicantly from 30 percent in 2000 to 2003 to 36 percent in 2008 to 2011r. he percentage of infants who survived without neurodevelopmental impairment also significantly grew from 16 percent to 20 percent during the same time period (Fig. 42-3). Although rates of survival without neurodevelopmental impairment increased over time among infants born at 23 and apercentage with disability at 2V2 years corrected age. The overall rate of disabilities includes performance on the
Bayley III assessments, mental development delay, cerebral palsy. and visual and hearing disabilities.
Data from Serenius F, I allen K, Blennow M, et al: infants at 2.5 years after active perinatal care in Sweden,