ABSTRACT
We investigated time-related predictors of death or neurological sequelae in extremely
preterm infants (EPI) born at 22 to 24 weeks' gestation by categorizing clinical patterns
according to their survival time and morbidity. Data on 113 infants born at 22 to
24 weeks' gestation from January 1991 through April 2006 were analyzed by a case-control
approach. Cesarean section, Apgar score ≤ 3 at 5 minutes, and pulmonary hypoplasia
were significantly associated with death at < 24 hours of life. Among infants who
survived ≥ 24 hours, pulmonary hemorrhage and intraventricular hemorrhage (IVH) were
significantly associated with death by day 6. Among those surviving ≥ 7 days, sepsis
and severe IVH were significantly associated with death. Assessment of survivors at
a minimum follow-up period of 2 years revealed that protracted mechanical ventilation
was significantly associated with a poor neurological outcome. There are various characteristic
key events in relation to the outcome at different ages of life in EPI born at 22
to 24 weeks' gestation. Clinicians and parents should discuss management options for
the infant on the basis of these findings.
KEYWORDS
Extremely preterm infant - limit of viability - mortality - morbidity - predictor
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Shigeo IijimaM.D.
Department of Neonatology, Toho University School of Medicine
6-11-1 Omorinishi, Ota-ku, Tokyo 143-8541, Japan
eMail: sige_pd@yahoo.co.jp
