Neonatal Outcome after Active Perinatal Management of the Very Premature Infant between 23 and 27 Weeks Gestation

OBJECTIVE: To record the effect of aggressive perinatal management on neonatal outcome in the very premature infant. METHODS: A retrospective chart review of 114 infants born between 23 and 27 weeks' gestation, managed by one perinatal transport service at one hospital between July 1989 and December 1993 Fetuses >23 weeks' gestation were considered viable and were managed with tocolytics, antibiotics, and surfactant at the discretion of the treating physician. Morbidity and mortality rates in the first 6 months, including stillbirths were analyzed. A major neurologic condition was defined as ultrasonographic evidence of grade 3 or 4 intraventricular hemorrhage or periventricular leukomalacia. RESULTS: Both neonatal mortality rate and the incidence of stillbirths decreased with advancing gestational age. Of 24 infants born at 23 weeks' gestation, 33% were stillborn and 13% were alive at 6 months. This survival rate improved to 48% for infants delivered at 24 weeks' gestation, and to 68%, 75%, and 71% for those delivered at 25, 26, and 27 weeks' gestation, respectively. The percentage of infants who survived without a major neurologic condition increased with advancing gestational age at delivery from 13% at 23 weeks' gestation to 40% at 24 weeks, 48% at 25 weeks, 70% at 26 weeks, and 71% at 27 weeks The incidence of retinitis of prematurity, respiratory complications, and days spent in the hospital decreased with greater gestational age. CONCLUSIONS: An active plan of management for all gestations of >23.9 weeks seems appropriate.