Little is known about the survival and neurodevelopmental outcomes of extremely preterm infants with low birth weight. More data is needed to facilitate decisions regarding the initiation of treatment and resuscitation in this population. In this retrospective cohort study, 205 infants born between 22 and 26 weeks gestational age (GA) with a birth weight of less than 400 grams and with no major birth defects were studied to assess survival to discharge home or to 1 year (if still hospitalized) among infants who received active treatment. Active treatment was defined as the provision of any potentially lifesaving intervention after birth. Of the 205 infants, 49.3% received active treatment at birth; infants were more likely to have been exposed to antenatal steroids (93.1% of infants who received active treatment vs. 42.3% of infants who did not, p<0.001). At baseline, 59.0% of infants were female, 64.9% were singletons, and 86.8% were small for GA. Researchers found that overall, 26 of 205 infants (12.7%, 95% CI 8.5% to 18.0%) survived to discharge (n=25) or remained hospitalized (n=1) at 1 year. Of these, 19 infants were known to have survived to 18 to 26 months corrected age, and 74% of these infants had moderate or severe neurodevelopmental impairment. All infants who survived received active treatment at birth, and 25.7% of infants who received active treatment at birth survived (95% CI 17.6% to 35.4%). Increased survival was associated with advancing GA, from 16.7% (95% CI 6.4% to 32.8%) at 22 to 23 weeks GA to 32.4% (95% CI 18.0% to 49.8%) at 25 to 26 weeks GA (p< 0.001). Nearly all infants that did not receive active treatment died within 12 hours of birth. The leading causes of death were immaturity, respiratory distress syndrome, and severe intracranial hemorrhage. This study was limited by the small number of survivors with follow-up to toddlerhood, which may preclude generalizability of the study. Overall, this study illustrates the significant mortality and morbidity of preterm infants with low birth weight, but shows that survival is possible.
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