765 - Optimising Outcomes at Extreme Preterm Gestations: The Experience of an Irish Tertiary Care Centre

Publication Number: 2746.765

Stephen Carroll, The Coombe Hospital, Dublin, Kilmainham, Dublin, Ireland; Sarah McDonnell, The Coombe Hospital, Dublin, Dublin, Ireland; Lama Alghawas, University College Dublin, Dublin, Dublin, Ireland; Amy C. OHiggins, University College Dublin, Dublin, Dublin, Ireland; Jan Miletin, The Coombe Hospital, Dublin, Dublin, Ireland; Anne Doolan, The Coombe Womens Hospital, Dublin, Dublin, Ireland; Jana Semberova, The Coombe Hospital, Dublin 8, Dublin, Ireland

Background: Recommendations on the clinical approach to obstetric and neonatal care at the limits of viability vary by country and region. In Ireland, the most recent national guideline on the management of extreme pre-term birth was published in 2021 and considered pregnancies after 23+0 weeks of gestation, with birth at earlier gestational ages not covered by the guideline.

Objective: To identify clinical factors that influenced survival following extreme pre-term birth in an Irish tertiary care centre

Design/Methods: A retrospective chart review of maternal and neonatal charts was undertaken for all births occurring between 22+0 and 24+6 weeks gestation at our centre in the years 2023 and 2024

Results: During the 24 months reviewed 51 infants were born between 22+0 and 24+6 weeks' gestational age (GA), from 37 pregnancies in 36 mothers. Of the infants 51% (26/51) were from a multiple pregnancy; with 25 singleton infants, 20 twins and 6 triplets. The mean maternal age was 33.4 years (range 24-46), the mean maternal first trimester BMI was 33.6 kg/m2 (range 19.2 - 41.3), 22% (8/37) had an identifiable risk factor for pre-term birth not including multiple pregnancy. There were 3 intrauterine fetal deaths, 1 in a triplet pregnancy and 2 in twin pregnancies, 1 infant experienced a delivery room death following intensive care in a pregnancy complicated by stage 4 twin to twin transfusion syndrome and fetal hydrops. Of the remaining 47 infants there were 6 who experienced early neonatal death following a combined parental-multidisciplinary team decision to proceed with comfort care and 41 who received neonatal intensive (NICU) care with overall survival of 46% (19/41). The mean birthweight of those who received NICU care was 594g (range 321 - 860). Survival at 22+0 - 22+6 was 60% (3/5) compared to survival of 21.4% (3/14) in 23+0 - 23+6 group and survival of 59% (13/22) for birth at 24+0 -24+6. Outcomes by GA are given in Figures 1 and 2. VON morbidity was low in those who survived (Figure 3).

Conclusion(s): Infant survival with minimal morbidity is possible following birth occurring before 23+0 weeks GA in an Irish setting. Future national guidelines on care at extreme pre-term gestations should reflect these findings.

Figure 1
Sankey diagram of infant outcomes by GA at birth (n=47)

Figure 2
Outcomes by GA at birth of infants receiving neonatal intensive care (n=41)