The Impact Of Antenatal Interventions On Neonatal Survival For Periviable Infants

To assess the impact of antenatal corticosteroids and magnesium sulfate on neonatal outcomes among periviable neonates born from 22w0d-25w6d; to describe the rate of intervention and survival to discharge by year (2013-2019) for fetuses born before 25w0d gestation A retrospective cohort study of periviable deliveries (22w0d-24w6d) from 2013-2019 at a single institution was conducted. Deliveries were excluded if neonatal resuscitation was not desired or offered. Deliveries were grouped by antenatal interventions (corticosteroids, magnesium sulfate, tocolytics). The primary outcome was neonatal survival to discharge. Secondary outcomes included a composite of neonatal morbidity and mortality (neonatal death, grades 3/4 interventricular hemorrhage, chronic lung disease, stage 3-5 retinopathy of prematurity). Neonatal survival to discharge and neonatal intervention (defined as receiving at least one dose of corticosteroids or magnesium sulfate prior to delivery) were compared by delivery year. After exclusion, 198 deliveries of 230 neonates were included in the cohort. Baseline characteristics were similar between the treatment and no treatment groups. Both corticosteroids and magnesium sulfate were associated with higher neonatal survival to delivery when compared to no treatment (65.4% vs 40.0% p 0.01; and 67.4% vs 48.3%, p 0.01). There was no association between the composite of neonatal morbidity and antenatal treatments. The use of corticosteroids was not associated with decreased rates of IVH (20.0% vs 23.9%; p 0.66) Use of prophylactic treatment for GBS was associated with increased survival. There was a trend toward increasing rates of neonatal survival to discharge and delivery year. This small cohort of pregnancies from 22w0d-25w6d found a positive association between antenatal corticosteroids, magnesium sulfate, and GBS prophylaxis with survival to discharge. No relationship between corticosteroids administration and IVH was found.View Large Image Figure ViewerDownload Hi-res image Download (PPT)