Changes in perinatal management and outcomes in infants born at 23 weeks of gestational age during the last decade in Spain

• Published in: The journal of maternal-fetal & neonatal medicine Vol. 35; no. 26; p. 10296
• Main Authors: Porta, Roser, Ventura, Paula Sol, Ginovart, Gemma, García-Muñoz, Fermín, Ávila-Alvarez, Alejandro, Izquierdo, Montserrat
• Format: Journal Article
• Language: English
• Published: England 30.12.2022
• Subjects: Female; Gestational Age; Humans; Infant; Infant Mortality; Infant, Newborn; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Parturition; Pregnancy; Retrospective Studies; Spain - epidemiology; Spain; 23 weeks; perinatal care; Extreme prematurity; mortality; NICU activity; morbidity; limit of viability
• ISSN: 1476-4954
• DOI: 10.1080/14767058.2022.2122801

The 2021-updated guidelines of the Spanish Society of Neonatology Guidelines have moved the zone of parental discretion to 23 + 0-23 + 6 weeks. The objective of this study was to describe the changes in perinatal management at this gestational age along the last decade and to determine if a more active perinatal management has contributed to improved outcomes. Retrospective analysis of prospectively collected data from the 23-week infants included in the Spanish SEN 1500 neonatal network during the period 2010-2019. The main study outcomes were survival at discharge and survival without major morbidity of actively managed infants. Two periods were compared: 2010-2014 (Period 1) and 2015-2019 (Period 2). NICUs were classified into low activity NICUs (less than 50 admissions of very low birth weight infants per year) and high activity NICUs (50 or more admissions). A total of 381 infants were included, 182 in Period 1 and 199 in Period 2. In Period 2 an increase in the use of intrapartum magnesium sulfate (21.5% vs 39.9%, .002), antenatal steroids (56.6% vs 69.3%, .011) and active neonatal approach in delivery room (76.9% vs 86.9%, .011) were observed.The clinical outcomes of the actively managed 313 infants were similar in both periods, except for less arterial hypotension in Period 2. Survival was 27.1% in Period 1 and 25% in Period 2 ( .068) and survival without major morbidity was 2.1% and 2.3% respectively ( .914). No difference was found between low and high activity NICUs. A change to a more active intention to treat infants born at 23 weeks is taking place in Spain. But the survival rate of the actively-managed infants has remained stable around 25-30% during the study period. A multidisciplinary effort is needed to improve outcomes in this population.