Preemies might survive at 22 weeks, if treated

NICU BabyUniversity of Iowa researchers have discovered that a small number of very preterm infants can survive if they receive potentially lifesaving treatment, but not all academic medical centers do this.

Matthew Rysavy
Edward Bell

Matthew Rysavy (’15 MD), a recent graduate of the UI Carver College of Medicine, and Edward Bell, MD, professor of pediatrics in the Stead Family Department of Pediatrics, studied the cases of nearly 5,000 infants born before 27 weeks gestation at 24 academic hospitals participating in the Neonatal Research Network between 2006 and 2011. The network is part of the Eunice Kennedy Shriver National Institute of Child Health and Human Development.

In a study published in the May 7 issue of the New England Journal of Medicine, the researchers found that much of the difference in outcomes could be explained by whether efforts were made to save the life of the youngest infants after they were born. At most centers, active care was not provided for infants born before 22 weeks. Active care was provided for all infants born at or after 25 weeks at almost all hospitals. However, between these two extremes—for infants born 22, 23, or 24 weeks into pregnancy—there was substantial variation among hospitals in whether infants were actively treated or provided only comfort care.

Infants born at 22 weeks received potentially lifesaving treatment at fewer than one in four hospitals, while infants born at 23 weeks received the same treatment at one in three hospitals.

“There is a real problem if doctors are talking to parents about their baby’s chances using outcome data that include babies for whom no active treatment was offered,” Bell says. “What parents want to know is, ‘If our baby is treated, what are her chances?'”