{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T23:16:53Z","timestamp":1783639013669,"version":"3.55.0"},"reference-count":18,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>This study aimed to evaluate the impact of Active Perinatal Treatment (AT) for 22-week live births on national 1-year survival trends to guide clinical decisions and counseling.<\/jats:p>\n                  <jats:p>We utilized U.S. natality data (2019\u20132022) to identify a cohort of non-anomalous, singleton live births at 22 weeks' gestation. The cohort was divided into two groups: AT and Non-Active Perinatal Treatment (Non-AT). AT was defined as receiving more than one of the following: Antenatal corticosteroids, cesarean delivery, neonatal intensive care unit (NICU) admission, neonatal antibiotics, surfactant, or mechanical ventilation (immediate or for &gt;6\u2009hours). Maternal and neonatal outcomes were compared between the two groups, and a Cox proportional hazards model adjusted for maternal age, race, education, prepregnancy medical history, and birth weight was used to assess adjusted hazard ratios (aHRs) for mortality within the first year of life. A subanalysis was performed to compare the neonatal and postneonatal survival rates among the two groups and over time.<\/jats:p>\n                  <jats:p>Of the 4,994 live births at 22 weeks, 2,769 (55.4%) received AT, and 2,225 (44.6%) were in the Non-AT group. One-year survival rate for the AT group was estimated at 34% compared with 8.6% in the Non-AT group. AT reduced the mortality hazard by 63% during the first year of life (aHR\u2009=\u20090.37; 95% CI: 0.34\u20130.39, p\u2009&lt;\u20090.001). From 2019 to 2022, AT use increased from 49.8% to 63.9%, paralleled by improved survival (p\u2009&lt;\u20090.003). Neonatal and postneonatal survival rates were higher with AT compared with the Non-AT for each year (p\u2009&lt;\u20090.001).<\/jats:p>\n                  <jats:p>Active treatment at 22 weeks significantly improves the 1-year survival. Its rising national use reflects growing clinical acceptance and highlights a potential shift in the threshold of viability in U.S. neonatal care.<\/jats:p>","DOI":"10.1055\/a-2901-9163","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T22:39:44Z","timestamp":1783636784000},"source":"Crossref","is-referenced-by-count":0,"title":["National Survival Rates among 22-Week Live Births in the United States: Associations with Active Treatment"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0613-8022","authenticated-orcid":false,"given":"Sara","family":"Jaber","sequence":"additional","affiliation":[{"name":"Corewell Health William Beaumont University Hospital, United States","department":["Department of Obstetrics and Gynecology"]},{"name":"Oakland University William Beaumont School of Medicine, United States","department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huong N.Q.","family":"Tran","sequence":"additional","affiliation":[{"name":"Corewell Health Beaumont Research Institute, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Migliore","sequence":"additional","affiliation":[{"name":"Corewell Health William Beaumont University Hospital, United States","department":["Department of Pediatrics"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kara","family":"Patek","sequence":"additional","affiliation":[{"name":"Detroit Medical Center, School of Medicine, Wayne State University, United States","department":["Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Gonik","sequence":"additional","affiliation":[{"name":"Detroit Medical Center, School of Medicine, Wayne State University, United States","department":["Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karoline","family":"Puder","sequence":"additional","affiliation":[{"name":"Corewell Health William Beaumont University Hospital, United States","department":["Department of Obstetrics and Gynecology"]},{"name":"Oakland University William Beaumont School of Medicine, United States","department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeynep","family":"Alpay-Savasan","sequence":"additional","affiliation":[{"name":"Corewell Health William Beaumont University Hospital, United States","department":["Department of Obstetrics and Gynecology"]},{"name":"Oakland University William Beaumont School of Medicine, United States","department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray","family":"Bahado-Singh","sequence":"additional","affiliation":[{"name":"Corewell Health William Beaumont University Hospital, United States","department":["Department of Obstetrics and Gynecology"]},{"name":"Oakland University William Beaumont School of Medicine, United States","department":["Department of Obstetrics and Gynecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1097\/AOG.0000000000000243","article-title":"Periviable birth: Executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists","volume":"123","author":"T NK Raju","year":"2014","journal-title":"Obstet Gynecol"},{"issue":"04","key":"ref2","doi-asserted-by":"crossref","first-page":"e187","DOI":"10.1097\/AOG.0000000000002352","article-title":"Obstetric Care Consensus No. 6: Periviable birth","volume":"130","author":"American College of Obstetricians and Gynecologists","year":"2017","journal-title":"Obstet Gynecol"},{"issue":"12","key":"ref3","first-page":"CD004454","article-title":"Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth","volume":"12","author":"E McGoldrick","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"issue":"02","key":"ref4","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.clp.2017.01.009","article-title":"Survival of infants born at periviable gestational ages","volume":"44","author":"R M Patel","year":"2017","journal-title":"Clin Perinatol"},{"issue":"04","key":"ref5","doi-asserted-by":"crossref","first-page":"e2024065963","DOI":"10.1542\/peds.2024-065963","article-title":"Survival of infants born at 22 to 25 weeks' gestation receiving care in the NICU: 2020-2022","volume":"154","author":"E M Edwards","year":"2024","journal-title":"Pediatrics"},{"issue":"01","key":"ref6","doi-asserted-by":"crossref","first-page":"53","DOI":"10.3345\/cep.2024.01277","article-title":"Need for national guidance regarding proactive care of infants born at 22-23 weeks' gestation","volume":"68","author":"G W Jeon","year":"2025","journal-title":"Clin Exp Pediatr"},{"issue":"01","key":"ref7","doi-asserted-by":"crossref","first-page":"151537","DOI":"10.1016\/j.semperi.2021.151537","article-title":"Creating experiences from active treatment towards extremely preterm infants born at less than 25 weeks in Japan","volume":"46","author":"S Kusuda","year":"2022","journal-title":"Semin Perinatol"},{"issue":"11","key":"ref8","doi-asserted-by":"crossref","first-page":"1558","DOI":"10.1038\/s41372-025-02268-3","article-title":"Neurodevelopmental outcomes at age 3 years of preterm infants born at 22-31 weeks' gestation","volume":"45","author":"Y Kono","year":"2025","journal-title":"J Perinatol"},{"key":"ref9","doi-asserted-by":"crossref","first-page":"105321","DOI":"10.1016\/j.earlhumdev.2021.105321","article-title":"Changes in mortality rates among extremely preterm infants born before 25 weeks' gestation: Comparison between the 2005 and 2010 nationwide surveys in Japan","volume":"155","author":"K Itabashi","year":"2021","journal-title":"Early Hum Dev"},{"issue":"12","key":"ref10","doi-asserted-by":"crossref","first-page":"4048","DOI":"10.3390\/jcm12124048","article-title":"Increased survival concomitant with unchanged morbidity and cognitive disability among infants born at the limit of viability before 24 gestational weeks in 2009-2019","volume":"12","author":"Y Christiansson","year":"2023","journal-title":"J Clin Med"},{"issue":"01","key":"ref11","doi-asserted-by":"crossref","first-page":"e20173324","DOI":"10.1542\/peds.2017-3324","article-title":"An international comparison of death classification at 22 to 25 weeks' gestational age","volume":"142","author":"L K Smith","year":"2018","journal-title":"Pediatrics"},{"key":"ref13","doi-asserted-by":"crossref","first-page":"176S","DOI":"10.1097\/01.AOG.0000514121.11806.ec","article-title":"The Risk of Preterm Birth in Pregnancies With Fetal Anomalies","volume":"129","author":"V Berger","year":"2017","journal-title":"Obstetrics & Gynecology"},{"issue":"07","key":"ref16","doi-asserted-by":"crossref","first-page":"101989","DOI":"10.1016\/j.ajogmf.2026.101989","article-title":"Improving 1-year survival at 22 weeks gestation: which perinatal interventions matter?","volume":"8","author":"S Jaber","year":"2026","journal-title":"Am J Obstet Gynecol MFM"},{"issue":"19","key":"ref18","doi-asserted-by":"crossref","first-page":"1801","DOI":"10.1056\/NEJMoa1410689","article-title":"Between-hospital variation in treatment and outcomes in extremely preterm infants","volume":"372","author":"M A Rysavy","year":"2015","journal-title":"N Engl J Med"},{"issue":"06","key":"ref19","doi-asserted-by":"crossref","first-page":"101566","DOI":"10.1016\/j.siny.2024.101566","article-title":"High-frequency jet ventilation in ELBW infants: A review and update","volume":"29","author":"E D Richards","year":"2024","journal-title":"Semin Fetal Neonatal Med"},{"issue":"02","key":"ref20","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.ajog.2020.07.051","article-title":"Proactive neonatal treatment at 22 weeks of gestation: A systematic review and meta-analysis","volume":"224","author":"C H Backes","year":"2021","journal-title":"Am J Obstet Gynecol"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1038\/s41372-018-0248-y","article-title":"Outcomes following a comprehensive versus a selective approach for infants born at 22 weeks of gestation","volume":"39","author":"C H Backes","year":"2019","journal-title":"J Perinatol"},{"issue":"07","key":"ref22","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1056\/NEJMoa1605566","article-title":"Survival and neurodevelopmental outcomes among periviable infants","volume":"376","author":"N Younge","year":"2017","journal-title":"N Engl J Med"}],"container-title":["American Journal of Perinatology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2901-9163.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T22:39:51Z","timestamp":1783636791000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2901-9163"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":18,"URL":"https:\/\/doi.org\/10.1055\/a-2901-9163","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0735-1631","1098-8785"],"issn-type":[{"value":"0735-1631","type":"print"},{"value":"1098-8785","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]}}}