Morbidity and Mortality Trends in Preterm Neonates at the Limits of Viability: Retrospective Observations from One Greek Hospital

The survival and health outcomes of extremely preterm neonates (PNs) remain a critical challenge in neonatal intensive care. This 5-year retrospective, observational study evaluated morbidity and mortality trends in PNs born at the limits of viability and identified survival patterns and associated risk factors. It was conducted from 2017 to 2022 on a dataset of PNs born between 22 + 0 and 26 + 0 weeks of gestation in a tertiary public hospital in Greece. A total of 73 PNs were included. The mortality rate was 56.2%. The median gestational age was 24.3 weeks, and the mean birth weight was 603.6 g. Survival improved significantly with a higher gestational age and birth weight. Respiratory distress syndrome was the most prevalent morbidity (71-94%), followed by late-onset sepsis (35.3%) and patent ductus arteriosus (29.4%). The use of antenatal corticosteroids and enteral feeding were associated with improved survival rates. Survivors required prolonged respiratory support and demonstrated better outcomes with early and adequate nutritional support. We conclude that the gestational age, birth weight, and effective respiratory and nutritional interventions are critical determinants of survival in neonates at the limits of viability. Enhancing neonatal care protocols with targeted interventions, such as antenatal corticosteroid use and evidence-based nutritional practices, could significantly improve outcomes in this vulnerable population.