In-hospital and 12–24-month neurodevelopmental outcomes in periviable infants across two epochs: a cohort study from a tertiary neonatal unit in India

The periviable period represents the earliest stage of foetal maturity, where survival outside the womb is possible but uncertain. With no national consensus on periviable care, management depends on family preferences, clinical expertise, and available resources. This study evaluates outcomes of periviable infants in a tertiary-care neonatal unit. To assess mortality, in-hospital morbidities, and neurodevelopmental outcomes in periviable infants across two time periods. This retrospective cohort included infants born between 23 + 0 and 26 + 0 weeks, who received active intensive care and survived beyond 12 hours, from January 2017 to December 2023. Two epochs were defined: 2017-20 (epoch 1) and 2021-23 (epoch 2), to evaluate the impact of evolving perinatal and neonatal practices on outcomes (survival and morbidities). Neurodevelopmental follow-up was performed at 1-2 years corrected age using the Developmental Assessment Scale for Indian Infants (DASII). Data analysis was performed using SPSS. Among 140 infants (71 epoch 1, 69 epoch 2), baseline gestational age and birth weight were comparable. Mortality was 42.3% in epoch 1 vs. 30.4% in epoch 2 (P = .15). Bronchopulmonary dysplasia (BPD) rates were 40% vs. 45% (P = .66). The composite outcome of death/BPD was 67.7% vs. 60.7% (P = .41). Neurodevelopmental delay was seen in 36% vs. 42.9% (P = .77). None of the differences were statistically significant. Periviable infants continue to have high mortality, morbidity, and neurodevelopmental impairment. No significant improvements in survival or BPD rates were observed between epochs.