# Determinants of survival in extremely preterm infants born at 22–23 weeks: a retrospective cohort study

## TL;DR

The study identifies factors affecting survival in extremely preterm infants born at 22–23 weeks, including birth weight and complications like infections and bleeding.

## Contribution

The study provides new insights into specific risk factors and interventions that may improve survival rates in extremely preterm infants.

## Key findings

- Lower birth weight and being small for gestational age are strongly associated with higher mortality.
- Complications like pneumothorax, intestinal perforation, and sepsis significantly increase the risk of death.
- Cesarean delivery is linked to a reduced risk of mortality in these infants.

## Abstract

This study investigated the risk factors associated with mortality in infants born at 22–23 weeks and assessed the impact of different variables on survival outcomes.

This retrospective study included 185 infants born at 22–23 weeks at a single tertiary care center (2006–2023). Univariate and logistic regression analyses identified independent predictors of mortality.

Among 185 infants, 64 (34.6%) did not survive. Mortality was associated with a lower birth weight (509 g vs. 564 g, p = 0.0001) and higher rates of small for gestational age (SGA; 21.9% vs. 7.4%, p = 0.009). Independent predictors included SGA [odds ratio (OR): 5.8], tension pneumothorax (OR: 9.9), severe intraventricular hemorrhage (OR: 3.3), focal intestinal perforation (OR: 4.1), necrotizing enterocolitis (OR: 18.9), and early-onset sepsis (OR: 9.7). Cesarean delivery was associated with reduced mortality (OR: 0.3).

Targeted management of these risk factors and cesarean delivery may improve the outcomes in this population.