Survival and neonatal morbidity at the limits of viability in the mid 1990s: 22 to 25 weeks

Objective: We determined neonatal survival and morbidity rates based on bot h fetal (stillborn) and neonatal deaths for infants delivered at 22 to 25 w eeks' gestation. Study design: Two hundred seventy-eight deliveries at 22 to 25 weeks' compl eted gestation were analyzed by gestational age groups between January 1993 and December 1997. Logistic regression models were used to identify matern al and neonatal factors associated with survival. Results: The rate of fetal death was 24%; 76% of infants were born alive an d 46% survived to discharge. Survival rates including fetal death at 22, 23 , 24, and 25 weeks were 1.8%, 34% 49%, and 76%; and survival rates excludin g fetal death were 4.6%, 46%, 59%, and 82%, respectively Logistic regressio n analyses showed that higher gestational age (P < .0002), higher birth wei ght (P < .001), female sex (P < .005), and surfactant (P < .003) were assoc iated with neonatal survival. Cesarean section was associated with decrease d survival (P < .006). Conclusion: Hospital neonatal survival rates of infants at the Limits of vi ability are significantly lower with the inclusion of fetal deaths. This in formation should be considered when providing prognostic advice to Families when mothers are in labor at 22 to 25 weeks' gestation.