TY - JOUR
T1 - Improved survival of periviable infants after alteration of the threshold of viability by the neonatal resuscitation program 2015
AU - Chen, Yen Ju
AU - Yu, Wen Hao
AU - Chen, Li Wen
AU - Huang, Chao Ching
AU - Kang, Lin
AU - Lin, Hui Shan
AU - Iwata, Osuke
AU - Kato, Shin
AU - Hussein, Mohamed Hamed
AU - Lin, Yung Chieh
N1 - Funding Information:
Acknowledgments: We acknowledge the intensive care provided for periviable infants by our colleagues: Yuh-Jyh Lin, Yu-Shan Chang, and the nurses. We acknowledge the nutritional support provided by the Taipei City Human Milk Bank and Taiwan Southern Human Milk Bank. We acknowledge Tzu-Yu Liu for assisting with the infants in the clinic. We acknowledge the doctors and nurses from the Center for Maternal-Fetal and Neonatal Medicine of the Saitama Medical University, the Neonatal Intensive Care Unit of Women and Infants Hospital in Rhode Island, the Neonatal Intensive Care Units (NICU) at New York Presbyterian Hospital, and the Neonatal Intensive Care Unit of the Saint Barnabas Medical Center. We acknowledge the Takeda Science Foundation for supporting the author to study in Japan. For statistical consulting services, we are grateful to Shang-Chi Lee from MUSETW DATA CO., LTD.
Funding Information:
Funding: This research was funded by NCKUH-10903038 from the National Cheng Kung University Hospital and by MOST 108-2321-B-006-023-MY2 from the Ministry of Science and Technology, Taiwan. The funds aided in the fees required for the data analysis, English editing, and publication process.
Publisher Copyright:
© 2021 by the authors. Licensee MDPI, Basel, Switzerland.
PY - 2021/1
Y1 - 2021/1
N2 - 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.
AB - 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.
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U2 - 10.3390/children8010023
DO - 10.3390/children8010023
M3 - Article
AN - SCOPUS:85102861006
SN - 2227-9067
VL - 8
JO - Children
JF - Children
IS - 1
M1 - 23
ER -