Management and outcomes of periviable infants in Slovenia: a decade of experience.

OBJECTIVES

To determine rates of active approach, mortality, and morbidity for periviable infants at level 3 maternity hospital between 2013 and 2022.

METHODS

Single center retrospective cohort study including mothers and their liveborn infants at gestational age from 22+0 weeks to 24+6 weeks during a ten-year period. Clinical data regarding pregnancy, delivery, neonatal mortality, and morbidity were collected from the Vermont Oxford Network (VON) database.

RESULTS

A total of 185 liveborn infants with gestational age (GA) from 22+0 to 24+6 weeks were included. A high proportion of the most immature infants were not treated actively (92 % infants born at 22 weeks of GA died in delivery room). Survival rates according to GA were 4 % (22 weeks), 40.7 % (23 weeks), and 65.1 % (24 weeks). Of the infants admitted to the neonatal intensive care unit (n=142), 25.3 % had severe intraventricular hemorrhage (grade III or IV) or periventricular leukomalacia, 13.4 % underwent abdominal surgery (due to necrotizing enterocolitis), and 17.6 % required laser treatment for retinopathy of prematurity. Supplemental oxygen at 36 weeks postmenstrual age was required by 40.8 % infants.

CONCLUSIONS

At our center, which cares for more than 90 % of periviable newborns born in Slovenia, we achieved comparable survival and morbidity outcomes for actively approached liveborn periviable infants compared to those from developed countries reported in the literature. In the future, we aim to implement active antenatal care for pregnant women and infants born after completed 22 weeks of gestation and monitor the long-term outcomes of all infants born at the limit of viability.