Survival and Cause of Death among Extremely Preterm Infants Near the Limit of Viability

Abstract

Although active perinatal management including delivery room resuscitation has been known to be the primary determinant of mortality for extremely preterm (EPT) infants near the limit of viability, wide institutional variations are evident in the Korean Neonatal Network data regarding the mortality of infants born at 23–24 weeks’ gestation. Most EPT infants near the limit of viability died within a few days of life. According to recent studies, improved mortality rate attributable to fewer deaths due to pulmonary and infectious causes in the infants with 23–24 weeks’ gestation was associated with antenatal steroid use and active delivery room resuscitation. Quality improvements that involve identifying and applying the best clinical care strategies, which include gentle meticulous respiratory care and infection control strategies, might be primarily responsible for the nationwide improvement in the outcomes of periviable EPT infants. There is also a need for the development of effective treatments to overcome deaths related to bronchopulmonary dysplasia and severe intraventricular hemorrhage.