Outcomes of preterm infants born with marginal viability in a University Hospital in Thailand

Abstract

© 2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians) Aim: Reports of the outcomes of infants born with marginal viability in developing countries are limited. This study aimed to determine the mortality rate and major disabilities of extremely preterm infants. Methods: A retrospective cohort with a prospective part of neurodevelopmental assessment was performed in infants born at 23–25+6 weeks' gestational age (GA) who received active resuscitation and were admitted to neonatal intensive care unit during 2005–2015. Surviving infants were recruited for neurodevelopmental assessment including cognition, gross motor and neurosensory disorders. Major disability was defined as one of the following: severe cognitive impairment, severe cerebral palsy, blindness or deafness. Results: A total of 67 infants were enrolled (8, 22 and 37 in the 23, 24 and 25 weeks' GA groups, respectively). The overall mortality rate before discharge was 26%. Infants in the 23 and 24 weeks' GA groups had a significantly higher mortality rate than did those in the 25 weeks' GA group (42 vs. 10%). Of 50 survivors (aged 2–12 years), 3 and 2 had blindness and deafness, respectively. Cognitive function assessment in 37 survivors showed that 4 (11%) and 15 (40%) had severe and borderline cognitive impairment, respectively. Death or major disability was found in 100, 63 and 38% in the 23, 24 and 25 weeks' GA groups, respectively. Conclusion: In our centre, infants born at 23–24 weeks had a much higher chance of death or major disability than those born at 25 weeks' GA. Given such information, active management should be offered together with the family's involvement.