459 - If We Treat Them, They May Live: A Single Center’s Experience with Treating Neonates Born at 22 Weeks of Gestation

Poster Number: 459
Publication Number: 459.130

Uduak Akpan, Brody School of Medicine at East Carolina University, Greenville, NC, United States; Dmitry Tumin, Brody School of Medicine at East Carolina University, Greenville, NC, United States; Ryan T. Moore, ECU Pediatrics-Neonatology, Greenville, NC, United States

Background: The limit of viability has decreased over time, and more centers are now willing to resuscitate neonates born at 22 weeks. Survival of these neonates is also increasing, although concerns for poor neuro-developmental outcomes remain. Outcomes may vary between individual centers depending on the approach to management.

Objective: To describe a single center’s experience with the management of neonates born alive at 22 weeks of gestation.

Design/Methods: This study is a retrospective review of neonates born alive from January 2017 -December 2021, and admitted to a level IV Neonatal Intensive Care Unit. Maternal charts were reviewed for antenatal counseling and interventions, while neonatal charts were reviewed for resuscitation at birth, morbidities during hospital admission, and where available, neurodevelopmental outcomes at 18 months of age corrected for prematurity.

Results: Eighteen neonates were born alive to 16 mothers (cohort included 2 sets of twins). All except 1 were inborn. Nine mothers delivered due to preterm labor, 5 due to preterm pre-labor rupture of membranes with intra-amniotic infection, and 2 after antepartum hemorrhage. Fourteen mothers received antenatal counseling, 75% received antenatal steroids (25% received a full course) and 31% delivered via Caesarean section in honor of parental wishes. Three families chose resuscitation limited to intubation and 2 families opted for conditional resuscitation depending on the neonate’s clinical condition after delivery. All the neonates were actively resuscitated, with 5 surviving to discharge (28%). All survivors had at least 1 morbidity at discharge. Only one patient returned for follow-up at 18 months of age, corrected for prematurity. He was diagnosed with severe global developmental delay with cerebral palsy and hearing impairment. All other survivors, though known to have survived past their second birthdays, did not return for follow up at 18 months. Conclusion(s): Survival is possible in neonates born at 22 weeks of gestation, but there remains a high likelihood of morbidity in survivors. With adequate antenatal counseling at the limits of viability, decisions that are personalized to the families based on their values and preferences can be made.
 
Characteristics of infants surviving to discharge