Variations in survival outcomes of infants born at 22–23 weeks’ gestation by neonatal intensive care quality level in Korea

Survival outcomes for infants born at 22-23 weeks' gestation vary widely across neonatal units. This national, prospective cohort study evaluated 919 infants born at 22-23 weeks' gestation in South Korea between 2013 and 2022, using Korean Neonatal Network data. Infants were categorized based on the level of neonatal care: 785 in lower-level centers (Group A) and 134 in higher-level centers (Group B). Survival was significantly higher in Group B (64.9%) compared to Group A (29.3%) (P < 0.0001). Early deaths occurred more frequently and earlier in Group A. Proactive care-including antenatal corticosteroids, antenatal antibiotics, and immediate surfactant administration-was more common in Group B. Antenatal corticosteroid was significantly associated with reduced risk of death (hazard ratio 0.58; 95% confidence interval, 0.49-0.69; P < 0.0001). The timing of rapid decline in survival was delayed in higher-level centers. In addition, classifying institutions into higher- and lower-level groups according to the survival of infants born at 22-23 weeks' gestation (≥50% vs. <50%) provides a good reflection of the quality of neonatal care. These findings highlight the importance of proactive care and timely in utero transfer to higher-level units in improving survival for peri-viable infants.

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Journal
Scientific Reports
Published
2026-01-05
DOI
https://doi.org/10.1038/s41598-025-28428-1
Primary Topic
Neonatal Respiratory Health Research
Type
article
Field-Weighted Citation Impact
0.00

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article

Variations in survival outcomes of infants born at 22–23 weeks’ gestation by neonatal intensive care quality level in Korea

Yoo Rha Hong, Byoung KooK Lee, Mi Hyeon Gang, Moon Sung Park et al.
Scientific Reports
Neonatal Respiratory Health Research
article

Variations in survival outcomes of infants born at 22–23 weeks’ gestation by neonatal intensive care quality level in Korea

Yoo Rha Hong, Byoung KooK Lee, Mi Hyeon Gang, Moon Sung Park, Gyu Hong Shim, Su Hyun Koo, Woo Ryoung Lee, Shin Ae Yoon, Eun Sil Lee, Cheong Jun Moon, Eun Hee Lee, Yoonjoo Kim, Hye Won Park, Jae Won Shim, Myung Hee Lee, Ju Young Lee, Yeong Myong Yoo, Woo Sun Song, Eun Ae Park, Dohyun Kim, Eun Song Song, Sung Shin Kim, Na Mi Lee, Byong Sop Lee, Byung Min Choi, Mi Lim Chung, Ee Kyung Kim, Jisook Kim, Young Don Kim, Min Seon Choi, Jong Hee Hwang, Minkyung Oh, Sung- Hoon Chung, Jin A Lee, Ji Woong Jeon, Jun Hwan Song, Min Soo Park, Young-Ah Youn, Yong Sung Choi, Yea- Seul Han, Jin Kyung Kim, Hyun Seung Jin, Chang Won Choi, Yun Sil Chang, Jae Woo Lim, Shin Yun Byun, Hyun Seung Lee, Sae Yun Kim, Ki Won Oh, Hye-Rim Kim, Korean Neonatal Network, Jae Yeol Park, Kyung Hee Park, Ji Sook Park, Myo Jing Kim, Eui Kyung Choi, Soon Min Lee, Hyun Kyung Park, Ji- Eun Jeong, Eun Woo Nam, Ga Won Jeon, Saic Kim, Dong Woo Son, Eunsun Lee
article en

Abstract

Survival outcomes for infants born at 22-23 weeks' gestation vary widely across neonatal units. This national, prospective cohort study evaluated 919 infants born at 22-23 weeks' gestation in South Korea between 2013 and 2022, using Korean Neonatal Network data. Infants were categorized based on the level of neonatal care: 785 in lower-level centers (Group A) and 134 in higher-level centers (Group B). Survival was significantly higher in Group B (64.9%) compared to Group A (29.3%) (P < 0.0001). Early deaths occurred more frequently and earlier in Group A. Proactive care-including antenatal corticosteroids, antenatal antibiotics, and immediate surfactant administration-was more common in Group B. Antenatal corticosteroid was significantly associated with reduced risk of death (hazard ratio 0.58; 95% confidence interval, 0.49-0.69; P < 0.0001). The timing of rapid decline in survival was delayed in higher-level centers. In addition, classifying institutions into higher- and lower-level groups according to the survival of infants born at 22-23 weeks' gestation (≥50% vs. <50%) provides a good reflection of the quality of neonatal care. These findings highlight the importance of proactive care and timely in utero transfer to higher-level units in improving survival for peri-viable infants.

Scientific ReportsVol. 16(1)
Inje University (KR), Ewha Womans University (KR), Chungbuk National University (KR), Changwon National University (KR), Korea University (KR), Samsung (South Korea) (KR), Soonchunhyang University (KR), Severance Hospital (KR), Korea University Medical Center (KR), Dong-A University Hospital (KR), Soonchunhyang University Hospital Seoul (KR), Kyungpook National University Hospital (KR), Kosin University Gospel Hospital (KR), Asan Medical Center (KR), Samsung Medical Center (KR), Seoul National University Hospital (KR), Seoul National University Bundang Hospital (KR), Ansan University (KR), Gachon University Gil Medical Center (KR), Daegu Catholic University Medical Center (KR), Gyeongsang National University Hospital (KR), Konkuk University Medical Center (KR), The Catholic University of Korea St. Vincent's Hospital (KR), Chonnam National University Hospital (KR), Hallym University Kangnam Sacred Heart Hospital (KR), SNUH SMG-SNU Boramae Medical Center (KR), Chosun University Hospital (KR), Inje University Haeundae Paik Hospital (KR), Wonju Severance Christian Hospital (KR), Ajou University Hospital (KR), Kangbuk Samsung Hospital (KR), Konyang University Hospital (KR), Dongguk University Ilsan Hospital (KR), The Catholic University of Korea Uijeongbu St. Mary's Hospital (KR), Korea Institute of Materials Science (KR), Inje University Ilsan Paik Hospital (KR), The Catholic University of Korea Yeouido St. Mary's Hospital (KR), Inje University Busan Paik Hospital (KR), Sungae Hospital (KR), Kyung Hee University Medical Center (KR), Pusan National University Hospital (KR), Inje University Sanggye Paik Hospital (KR), Gwangmyeong Mental Health Welfare Center (KR), Daejeon Eulji Medical Center, Eulji University (KR), Keimyung University Dongsan Medical Center (KR), Jeonbuk National University Hospital (KR), The Catholic University of Korea Bucheon St. Mary's Hospital (KR), CHA University Bundang Medical Center (KR), Ulsan University Hospital (KR), Biomedical Research Institute (US), Gangneung Asan Hospital (KR), Chungnam National University Hospital (KR), Gangnam Severance Hospital (KR), CHA University (KR), Yeungnam University Medical Center (KR), Kyung Hee University Hospital at Gangdong (KR), Hanyang University Medical Center (KR), Chung-Ang University Hospital (KR), The Catholic University of Korea Seoul St. Mary's Hospital (KR), CHA University Gangnam Medical Center (KR), Jeju National University Hospital (KR), Dankook University Hospital (KR), Keimyung University (KR), Bucheon University (KR), Wonkwang University (KR), Jeonbuk National University (KR), Sungkyunkwan University (KR)
Korea National Institute of Health
Good health and well-being
Openalex Percentile: Top 97%
Neonatal Respiratory Health Research
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