Risk assessment of survival and morbidity of infants born at less than 24 completed weeks of gestation

Nicole Chapman-Hatchett, Nia Chittenden, Fahad Arattu Thodika, Emma Williams, Christopher Harris, Theodore Dassios, Anusha Arasu, Kathryn Johnson, Anne Greenough

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Abstract

Background: Infants born at the threshold of viability have a high risk of mortality and morbidity. The British Association of Perinatal Medicine (BAPM) provided updated guidance in 2019 advising a risk-based approach to balancing decisions about active versus redirected care at birth.
Aims: To determine the survival and morbidity of infants born between 22 to 24 completed weeks of gestation. To develop a scoring system to categorise infants according to risk for mortality or severe adverse outcome.
Methods: A retrospective, observational study of infants who received neonatal care in a single centre from 2011 to 2021. Data were collected on mortality, morbidity and two-year neurodevelopmental outcomes. Each infant was risk categorised utilising the proposed tools in the BAPM (2019) framework. A composite adverse score for either dying or surviving with severe impairment was created.
Results: Four infants born at 22 weeks, 49 at 23 weeks and 105 at 24 weeks of gestation were included. The overall mortality rate was 23.4%. Following risk categorisation there were 8 (5.1%) extremely high risk, 44 (27.8%) high risk and 106 (67.1%) moderate risk infants. The rate of dying or surviving with severe impairment for extremely high risk, high risk and moderate risk were 100%, 88.9% and 53% respectively. The proportions with the composite adverse outcome differed significantly according to the risk category (p<0.001).
Conclusions: When applying a scoring system to risk categorise infants, high rates of dying or surviving with severe impairment were found in infants born at 22 or 23 weeks of gestation.
Original languageEnglish
JournalEarly Human Development
Publication statusPublished - 2023

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