Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2025 Aug;92(8):844-852.
doi: 10.1007/s12098-024-05164-4. Epub 2024 Jun 5.

Enhanced Survival of 22-25 Week Preterm Infants After Proactive Care Implementation: A Comparative Analysis of Two Time Periods

Sae Yun Kim  1 , Jeongmin Shin  1 , Moon Yeon Oh  1 , Young-Ah Youn  2
Affiliations
Comparative Study

Enhanced Survival of 22-25 Week Preterm Infants After Proactive Care Implementation: A Comparative Analysis of Two Time Periods

Sae Yun Kim et al. Indian J Pediatr. 2025 Aug.

Abstract

Objectives: To investigate the impact of proactive perinatal care on periviable preterm infants before and after its implementation.

Methods: This retrospective cohort study was conducted over a period of 10 y, from 2013 to 2019, referred to as Phase I, and from 2020 to 2022, referred to as Phase II. A total of 162 eligible infants born between 220/7 and 256/7 wk of gestation were included in this analysis.

Results: A total of 125 infants were born in phase I, and 37 infants in phase II received proactive care with minimal handling. The mortality decreased from 54.4% to 24.3% (P = 0.001). The composite outcomes of severe brain injury or death, sepsis or death and necrotizing enterocolitis or death were also improved with proactive care. Gestational age [adjusted odds ratio (aOR) 0.900; 95% confidence interval (CI), 0.836-0.970], air leak syndrome (aOR 4.958; 95% CI, 1.681-14.624), massive pulmonary hemorrhage (aOR 4.944; 95% CI, 2.055-11.893), and birth in phase II (aOR 0.324; 95% CI, 0.115-0.912) were independently associated with mortality.

Conclusions: The implementation of proactive care with minimal handling resulted in an increased survival rate and a reduction in the combined morbidities between the two time periods. The provision of proactive perinatal care with minimal handling is crucial for improving both the survival rates and clinical outcomes of these vulnerable infants.

Keywords: Minimal handling; Mortality; Periviable preterm infant; Proactive perinatal care.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethical Approval: This study was approved by the Institutional Review Board (IRB) of Seoul St. Mary's Hospital (IRB No. KC21TISI0329). Informed consent from the parents of study participants was waived because of retrospective design with minimal risk. Conflict of Interest: None.

Figures

Fig. 1
Fig. 1
Flow chart of the study population. GA Gestational age, PMA Postmenstrual age, wkGA Weeks of gestational age
Fig. 2
Fig. 2
Infants born during the ten years. a Total number of periviable preterm infants born and survival rate for ten years. b Periviable preterm infants born for ten years by gestational week at birth
See this image and copyright information in PMC

References

    1. American College of Obstetricians and Gynecologists and the Society for Maternal–Fetal Medicine; Ecker JL, Kaimal A, Mercer BM, et al. # 3: Periviable birth. Am J Obstet Gynecol. 2015;213:604–14. - PubMed
    1. Raju TNK, Mercer BM, Burchfield DJ, Joseph GF Jr. Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. Am J Obstet Gynecol. 2014;210:406–17. - PubMed
    1. Lantos JD, Meadow W. Variation in the treatment of infants born at the borderline of viability. Pediatrics. 2009;123:1588–90. - PubMed
    1. Zhang W-W, Yu Y-H, Dong X-Y, Reddy S. Treatment status of extremely premature infants with gestational age <28 weeks in a Chinese perinatal center from 2010 to 2019. World J Pediatr. 2022;18:67–74. - PMC - PubMed
    1. García-Muñoz Rodrigo F, Diez Recinos AL, Garcia-Alix Perez A, Figueras Aloy J, Vento Torres M. Changes in perinatal care and outcomes in newborns at the limit of viability in Spain: the EPI-SEN Study. Neonatology. 2015;107:120–9. - PubMed

Publication types

LinkOut - more resources