Abstract

Objective: The aim of this study was to evaluate mortality, early morbidities, and critical prognostic thresholds in extremely preterm infants born at 22–26 weeks of gestation at the limit of periviability.

Materials and Methods: This retrospective single-center study included live-born infants between 22+0 and 26+6 weeks of gestation who were admitted to a tertiary 194-bed neonatal intensive care unit between June 1, 2021, and March 31, 2023. Prenatal, natal, and postnatal characteristics were analyzed. The primary outcome was mortality. Receiver operating characteristic (ROC) analysis was performed to determine optimal gestational age and birth weight cut-off values for predicting mortality.

Results: Among 11038 neonatal admissions during the study period, 263 (2.38%) were extremely preterm infants within the specified gestational age range. Overall mortality was 70.7%. Gestational age and birth weight were identified as the strongest independent predictors of survival. ROC analysis demonstrated significant cut-off values of 24.2 weeks for gestational age and 740 g for birth weight in predicting mortality. The most common early morbidities were patent ductus arteriosus (54.6%), culture-proven sepsis (38.7%), and osteopenia (28%). Survival improved markedly beyond 24 weeks of gestation, highlighting the critical prognostic importance of even small increments in maturity.

Conclusion: Biological immaturity remains the principal determinant of outcome in infants born at the threshold of viability. However, identification of clinically relevant gestational age and birth weight thresholds may guide prenatal counseling, individualized resuscitation decisions, and intensive care strategies to improve survival in this vulnerable population. Ultimately, achieving “quality survival” – survival without major disability – requires long-term neurodevelopmental follow-up beyond hospital discharge.

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Copyright © 2026 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Ertilav Mucuk MH, Tayman C. Beyond the threshold of viability: Mortality, morbidity, and critical prognostic cut-offs in infants born at 22–26 weeks of gestation. Turk J Pediatr Dis. 2026;Early View:1-7. https://doi.org/10.12956/TJPD.2026.1323