The rate of preterm birth in 2015 was 9.63% in the United States, which includes a smaller subset of periviable pregnancies. These neonates have a wide range of morbidity and mortality resulting from severe prematurity.METHODS:
We performed a descriptive study of neonates delivered at an academic hospital with a level IV NICU from 2011 to 2017. All neonates delivered at 22-25 6/7 weeks gestation were included. Subjects were identified using NICU and birth certificate databases.RESULTS:
A total of 212 neonates were included. 21.7% did not have active resuscitation and 2.4% of neonates did not require intubation in the delivery room. Survival was 0% at 22 weeks, 47.5% at 23 weeks, 76.4% at 24 weeks and 88.1% at 25 weeks. (p<0.0001). When stratified based on exact gestational age of delivery there was a linear trend that was observed with survival increasing and neonatal death decreasing with increasing gestational age but this did not reach statistical significance (p=0.31). Finally, there was a decreasing rate of vaginal delivery (100.0% at 22 weeks, 60.0% at 23 weeks, 32.8% at 24 weeks and 29.8% at 25 weeks) and increasing rate of cesarean delivery (0.0% at 22 weeks, 40.0% at 23 weeks, 67.2% at 24 weeks and 70.3% at 25 weeks) with increasing gestational age (p<0.0001).CONCLUSION:
We observed a high rate of survival with periviable preterm birth. As the survival rate of periviable neonates continues to increase, further information on the prediction of survival and risks associated with mode of delivery are needed.