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