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Increased Survival Concomitant with Unchanged Morbidity and Cognitive Disability among Infants Born at the Limit of Viability before 24 Gestational Weeks in 2009–2019

Introduction: The aim was to determine risk factors among mothers and outcomes for their children born at the limit of viability in 2009–2019, before and after the introduction of extended interventionist guidelines. Methods: A retrospective cohort study of births at 22 + 0–23 + 6 gestational weeks...

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Autores principales: Christiansson, Yasemin, Moberg, Maria, Rakow, Alexander, Stjernholm, Ylva Vladic
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10298897/
https://www.ncbi.nlm.nih.gov/pubmed/37373741
http://dx.doi.org/10.3390/jcm12124048
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author Christiansson, Yasemin
Moberg, Maria
Rakow, Alexander
Stjernholm, Ylva Vladic
author_facet Christiansson, Yasemin
Moberg, Maria
Rakow, Alexander
Stjernholm, Ylva Vladic
author_sort Christiansson, Yasemin
collection PubMed
description Introduction: The aim was to determine risk factors among mothers and outcomes for their children born at the limit of viability in 2009–2019, before and after the introduction of extended interventionist guidelines. Methods: A retrospective cohort study of births at 22 + 0–23 + 6 gestational weeks in a Swedish Region in 2009–2015 (n = 119), as compared to 2016–2019 (n = 86) after the introduction of new national interventionist guidelines. Infant mortality, morbidity, and cognitive functions at 2 years corrected age according to the Bayley-III Screening Test were monitored. Results: Maternal risk factors for extreme preterm birth were identified. The intrauterine fetal death rates were comparable. Among births at 22 weeks, the neonatal mortality tended to decrease (96 vs. 76% of live births (p = 0.05)), and the 2-year survival tended to increase (4 vs. 24% (p = 0.05)). Among births at 23 weeks, the neonatal mortality decreased (56 vs. 27% of live births (p = 0.01)), and the 2-year survival increased (42 vs. 64% (p = 0.03)). Somatic morbidity and cognitive disability at 2 years corrected age were unchanged. Conclusion: We identified maternal risk factors that emphasize the need for standardized follow-up and counseling for women at increased risk of preterm birth at the limit of viability. The increased infant survival concomitant with unchanged morbidity and cognitive disability highlight the importance of ethical considerations regarding interventionist approaches at threatening preterm birth before 24 weeks.
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spelling pubmed-102988972023-06-28 Increased Survival Concomitant with Unchanged Morbidity and Cognitive Disability among Infants Born at the Limit of Viability before 24 Gestational Weeks in 2009–2019 Christiansson, Yasemin Moberg, Maria Rakow, Alexander Stjernholm, Ylva Vladic J Clin Med Article Introduction: The aim was to determine risk factors among mothers and outcomes for their children born at the limit of viability in 2009–2019, before and after the introduction of extended interventionist guidelines. Methods: A retrospective cohort study of births at 22 + 0–23 + 6 gestational weeks in a Swedish Region in 2009–2015 (n = 119), as compared to 2016–2019 (n = 86) after the introduction of new national interventionist guidelines. Infant mortality, morbidity, and cognitive functions at 2 years corrected age according to the Bayley-III Screening Test were monitored. Results: Maternal risk factors for extreme preterm birth were identified. The intrauterine fetal death rates were comparable. Among births at 22 weeks, the neonatal mortality tended to decrease (96 vs. 76% of live births (p = 0.05)), and the 2-year survival tended to increase (4 vs. 24% (p = 0.05)). Among births at 23 weeks, the neonatal mortality decreased (56 vs. 27% of live births (p = 0.01)), and the 2-year survival increased (42 vs. 64% (p = 0.03)). Somatic morbidity and cognitive disability at 2 years corrected age were unchanged. Conclusion: We identified maternal risk factors that emphasize the need for standardized follow-up and counseling for women at increased risk of preterm birth at the limit of viability. The increased infant survival concomitant with unchanged morbidity and cognitive disability highlight the importance of ethical considerations regarding interventionist approaches at threatening preterm birth before 24 weeks. MDPI 2023-06-14 /pmc/articles/PMC10298897/ /pubmed/37373741 http://dx.doi.org/10.3390/jcm12124048 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Christiansson, Yasemin
Moberg, Maria
Rakow, Alexander
Stjernholm, Ylva Vladic
Increased Survival Concomitant with Unchanged Morbidity and Cognitive Disability among Infants Born at the Limit of Viability before 24 Gestational Weeks in 2009–2019
title Increased Survival Concomitant with Unchanged Morbidity and Cognitive Disability among Infants Born at the Limit of Viability before 24 Gestational Weeks in 2009–2019
title_full Increased Survival Concomitant with Unchanged Morbidity and Cognitive Disability among Infants Born at the Limit of Viability before 24 Gestational Weeks in 2009–2019
title_fullStr Increased Survival Concomitant with Unchanged Morbidity and Cognitive Disability among Infants Born at the Limit of Viability before 24 Gestational Weeks in 2009–2019
title_full_unstemmed Increased Survival Concomitant with Unchanged Morbidity and Cognitive Disability among Infants Born at the Limit of Viability before 24 Gestational Weeks in 2009–2019
title_short Increased Survival Concomitant with Unchanged Morbidity and Cognitive Disability among Infants Born at the Limit of Viability before 24 Gestational Weeks in 2009–2019
title_sort increased survival concomitant with unchanged morbidity and cognitive disability among infants born at the limit of viability before 24 gestational weeks in 2009–2019
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10298897/
https://www.ncbi.nlm.nih.gov/pubmed/37373741
http://dx.doi.org/10.3390/jcm12124048
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