|
1
|
Chen YJ, Yu WH, Chen LW, Huang CC, Kang L, Lin HS, Iwata O, Kato S, Hussein MH, Lin YC. Improved Survival of Periviable Infants after Alteration of the Threshold of Viability by the Neonatal Resuscitation Program 2015. CHILDREN-BASEL 2021; 8:children8010023. [PMID: 33406755 PMCID: PMC7824697 DOI: 10.3390/children8010023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 01/11/2023]
Abstract
Periviable infants (PIs) born at 22–25 weeks gestational age (wGA) have a variable survival rate (49.7–86.2%) among hospitals. One factor involved in this difference may be the definition of the threshold of viability. The American Academy of Pediatrics revised the neonatal resuscitation program in late 2015 (NRP 2015) and altered the threshold of viability from 23 to 22 wGA. The impact on the survival of PIs after the guideline alteration has seldom been discussed. Since 2016, the unit of this study has implemented the renewed guideline for PIs. We retrospectively reviewed and analyzed the survival and clinical variables of PIs before and after implementation of the guideline, which included a 10-year cohort in a single center in Taiwan. There were 168 PIs enrolled between 2010 and 2019 (Epoch-I, 2010–2015; Epoch-II, 2016–2019), after excluding those with congenital anomalies and parent-decided comfort care. Compared to those in Epoch-I, the PIs in Epoch-II had significantly higher odds ratios (2.602) (95% confidence interval: 1.170–5.789; p = 0.019) for survival. Younger gestational age, small size for gestational age, cesarean delivery, low blood pH at birth, and surfactant therapeutic treatment were found to be significant risk factors associated with the survival of PIs (p < 0.05 for each). The altered threshold of viability by NRP 2015 may impact the survival of PIs. However, long-term follow-up for surviving PI is required in the future.
Collapse
Affiliation(s)
- Yen-Ju Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
| | - Wen-Hao Yu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
| | - Li-Wen Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
| | - Lin Kang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan;
| | - Hui-Shan Lin
- Department of Nursing, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan;
| | - Osuke Iwata
- Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Science, Nagoya, Aichi 467-8601, Japan; (O.I.); (S.K.)
| | - Shin Kato
- Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Science, Nagoya, Aichi 467-8601, Japan; (O.I.); (S.K.)
| | - Mohamed Hamed Hussein
- Department of Neonatology, Center of Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama 350-8550, Japan
- Correspondence: (M.H.H.); (Y.-C.L.); Tel.: +81-492-283-727 (M.H.H.); +886-62353535-3236 (Y.-C.L.)
| | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
- Correspondence: (M.H.H.); (Y.-C.L.); Tel.: +81-492-283-727 (M.H.H.); +886-62353535-3236 (Y.-C.L.)
| |
Collapse
|