Improved survival of periviable infants after alteration of the threshold of viability by the neonatal resuscitation program 2015

Yen Ju Chen, Wen Hao Yu, Li Wen Chen, Chao Ching Huang, Lin Kang, Hui Shan Lin, Osuke Iwata, Shin Kato, Mohamed Hamed Hussein, Yung Chieh Lin

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18 Citations (Scopus)

Abstract

Periviable infants (PIs) born at 22–25 weeks gestational age (wGA) have a variable survival rate (49.7–86.2%) among hospitals. One factor involved in this difference may be the definition of the threshold of viability. The American Academy of Pediatrics revised the neonatal resuscitation program in late 2015 (NRP 2015) and altered the threshold of viability from 23 to 22 wGA. The impact on the survival of PIs after the guideline alteration has seldom been discussed. Since 2016, the unit of this study has implemented the renewed guideline for PIs. We retrospectively reviewed and analyzed the survival and clinical variables of PIs before and after implementation of the guideline, which included a 10-year cohort in a single center in Taiwan. There were 168 PIs enrolled between 2010 and 2019 (Epoch-I, 2010–2015; Epoch-II, 2016–2019), after excluding those with congenital anomalies and parent-decided comfort care. Compared to those in Epoch-I, the PIs in Epoch-II had significantly higher odds ratios (2.602) (95% confidence interval: 1.170–5.789; p = 0.019) for survival. Younger gestational age, small size for gestational age, cesarean delivery, low blood pH at birth, and surfactant therapeutic treatment were found to be significant risk factors associated with the survival of PIs (p < 0.05 for each). The altered threshold of viability by NRP 2015 may impact the survival of PIs. However, long-term follow-up for surviving PI is required in the future.

Original languageEnglish
Article number23
JournalChildren
Volume8
Issue number1
DOIs
Publication statusPublished - 2021 Jan

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health

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