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 both fetal (stillborn) and neonatal deaths for infants delivered at 22 to 25 weeks' gestation. Study design: Two hundred seventy-eight deliveries at 22 to 25 weeks' completed gestation were analyzed by gestational age groups between January 1993 and December 1997. Logistic regression models were used to identify maternal and neonatal factors associated with survival. Results: The rate of fetal death was 24%; 76% of infants were born alive and 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 excluding fetal death were 4.6%, 46%, 59%, and 82%, respectively Logistic regression analyses showed that higher gestational age (P < .0002), higher birth weight (P < .001), female sex (P < .005), and surfactant (P < .003) were associated with neonatal survival. Cesarean section was associated with decreased survival (P < .006). Conclusion: Hospital neonatal survival rates of infants at the Limits of viability are significantly lower with the inclusion of fetal deaths. This information should be considered when providing prognostic advice to Families when mothers are in labor at 22 to 25 weeks' gestation.