In the Gray Zone: Survival and Morbidities of Periviable Births

Science Center, Bent Corridor

Before the 1980s, the mortality for babies born before 24 weeks of gestation was almost 100%. As the use of antenatal steroids and surfactants rose, the definition of viability for premature infants has retreated toward 22 weeks of gestation. Many institutions remain unwilling to resuscitate infants born before 24 weeks of gestation, citing the high morbidities and mortality of being so premature. Nationally the survival rate for infants born at 22 weeks is 5-10%, which contrasts with the 35-55% chance of survival at 23 weeks. This study examines the history of periviable births at Cleveland’s MetroHealth System (MHS) from 2009 to 2016 and compares the morbidities and mortalities between infants born at 22 to 25 weeks of gestation. Electronic medical records of 187 infants born between 22 0/7 and 25 6/7 weeks at MHS between June of 2009 and December of 2016 were analyzed. Survival and long term morbidities of infants treated at MHS did not differ greatly between those born at 22 weeks of gestation and those born at 23 weeks. There was a 55% rate of survival for 22-weekers, and 53% rate of survival for 23-weekers, which differs sharply from the national data reported to parents at MHS. This low national percentage is inaccurate in that it includes a high percentage of infants that were not resuscitated as part of its sampling pool. Given the survival data obtained in this study, it is possible for MHS to consider treatment with antenatal steroids earlier than 22 6/7 weeks.