Clinical Patterns in Extremely Preterm (22 to 24 Weeks of Gestation) Infants in Relation to Survival Time and Prognosis

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 (lVH) 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.