For infants born at 22 weeks’ gestation, active treatment increased from 28.8 percent in 2014 to 78.6 percent in 2023, while survival rates increased from 25.7 percent in 2014 to 41.0 percent in 2023.
April 28, 2025 | Erin Bluvas, bluvase@sc.edu
Building on her previous research into maternal and infant health during pregnancy and after birth, epidemiology associate professor Nansi Boghossian has published new findings in JAMA. Collaborating with colleagues* from the Vermont Oxford Network and the University of Vermont, Boghossian investigated postnatal life support provided to infants born during the periviable period of pregnancy (between 22- and 25-weeks’ gestation) and their subsequent survival.
The researchers found that increased efforts to provide active treatment to infants
born at 22 and 23 weeks resulted in higher survival rates. For infants born at 22
weeks’ gestation, active treatment increased from 28.8 percent in 2014 to 78.6 percent
in 2023, while survival rates increased from 25.7 percent in 2014 to 41.0 percent
in 2023. Similarly, for infants born at 23 weeks’ gestation, active treatment increased
from 87.4 percent to 94.7 percent, with survival rates improving from 53.8 percent
to 57.9 percent.
The study utilized data collected between 2014 and 2023 from the Vermont Oxford Network Database Research Repository. The team analyzed records from 795 NICUs across the country, encompassing nearly 60,000 births of infants born at 22- to 25-weeks’ gestation. This data represents approximately 86 percent of all U.S. births within this gestational age range.
This shift can be attributed to advancements in medical technology, updated clinical guidelines, and publications highlighting differences in hospital practices for initiating active treatment and variation in outcomes. These factors have collectively shifted our previous understanding of the minimum gestational age required for an infant’s likely survival.
When examining changes in “active treatment,” the researchers defined these efforts as face mask ventilation, nasal continuous positive airway pressure, endotracheal intubation, surfactant therapy, mechanical ventilation, chest compressions, or epinephrine. They also explored variations in active treatment by race and ethnicity within this diverse population, finding similar changes over time across groups. However, Black infants were more likely than White infants to receive active treatment at 22- and 23-weeks’ gestation.
“Between 2014 and 2023, the increase in active treatment and survival was most notable at 22 weeks,” Boghossian says. “This shift can be attributed to advancements in medical technology, updated clinical guidelines, and publications highlighting differences in hospital practices for initiating active treatment and variation in outcomes. These factors have collectively shifted our previous understanding of the minimum gestational age required for an infant’s likely survival.”
*Co-authors include Lucy Greenburg, Erika Edwards, and Jeffrey Horbar (Vermont Oxford Network).
This research is supported by the National Institute on Minority Health and Health Disparities R01MD016012.