Outcomes in a cohort of preterm infants born at 22-23 weeks from a proactive center in Germany

Introduction: We describe survival, major neonatal morbidities and neurodevelopmental outcomes of preterm infants below 24 weeks’ GA in a German single- center cohort managed with an intensive care treatment approach. Methods: This retrospective single-center study included preterm infants born at 22+0 to 22+6 weeks’ and 23+0 to 23+6 weeks’ gestation (GA) between January 2008 and December 2022. Obstetric characteristics, delivery room management, short-term outcomes and neurodevelopmental outcomes at 22-28 months were described. Findings were compared with published data from other proactive centers. Results: Of 183 inborn infants, 143 received intensive care treatment, including 32 infants born at 22 weeks’ GA and 111 born at 23 weeks’ GA. Survival to discharge among actively treated infants was 75.0% (24/32) at 22 weeks and 84.7% (94/111) at 23 weeks. Moderate/severe Bronchopulmonary Dysplasia (BPD) occurred more frequently in 22-week than in 23-week infants (70.8% vs. 42.6%, p=0.02), and supplemental oxygen at discharge was more common (37.5% vs 16.0%, p=0.04). The rate of infants lost to follow-up was 20% in both groups. 47.4% of 22-week and 63.2% of 23-week infants had a Mental Development Index (MDI) ≥70 (no or mild impairment), whereas severe cognitive impairment (MDI <55) was present in 42.1% and 19.7%, respectively. Conclusion: In this experienced center with an intensive care treatment approach, survival of infants born at 22+0 to 23+6 weeks GA was high. However, neonatal morbidity and neurodevelopmental impairment remained substantial, particularly among 22-week infants. Future efforts should focus on improving long-term outcomes in addition to survival.