Neonatal outcome of infants born at 23 weeks' gestation

Objective: To determine the neonatal outcome in accurately dated 23-week de liveries. Methods: We reviewed the records of consecutive births between 23 0/7 and 2 3 6/7 weeks at Brigham & Women's Hospital, Boston, Massachusetts, from Janu ary 1995 to December 1999. Women were excluded if they presented for electi ve termination or had known fetal death or poor dating criteria. Neonatal r ecords were abstracted for mortality and short-term morbidity, including th e respiratory distress syndrome (RDS), intraventricular hemorrhage, chronic lung disease, necrotizing enterocolitis, periventricular leukomalacia, and retinopathy of prematurity. Survival was defined as discharge from neonata l intensive care. Results: Thirty-three singleton pregnancies met criteria for inclusion, 11 of whom survived to discharge (survival rate 0.33; 95% CI 0.18, 0.52). More advanced gestational age was associated with increased likelihood of survi val: 0 of 12 at 23 0/7 to 23 2/7 weeks, 4 of 10 at 23 3/7 to 23 4/7 weeks, and 7 of 11 at 23 5/7 to 23 6/7 weeks (P = .02). All 11 survivors developed RDS and chronic lung disease. One of II survivors had necrotizing enteroco litis, and 2 of 11 had severe retinopathy of prematurity. One survivor had periventricular leukomalacia on head ultrasonography, compared with 7 of th e nonsurvivors who had head ultrasonography (P = .03). One survivor develop ed severe intraventricular hemorrhage (grade 3 or 4) compared with 8 of the 12 at-risk nonsurvivors who had head ultrasonography (P = .01). Conclusion: About one third of infants delivered at 23 weeks' gestation sur vived to be discharged from neonatal intensive care. More advanced gestatio nal age was associated with increased likelihood of survival. No neonates s urvived free of substantial morbidity. (Obstet Gynecol 2001;97:49 -52. (C) 2001 by The American College of Obstetricians and Gynecologists.)