Wide International Variation in Survival and Morbidity for Infants Born at 22–23 Weeks: Implications for Care, Counseling, and Research

Highlight

Four key takeaways from the iNeo 2025 cohort analysis:

– Survival to neonatal discharge for infants born at 22–23 weeks varied markedly across 11 neonatal networks (adjusted ranges 9%–64% at 22 weeks and 16%–80% at 23 weeks).
– Major morbidities (severe intraventricular hemorrhage [grade 3–4 PVH], cystic periventricular leukomalacia, treated retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis) also showed substantial between‑network differences.
– Much of the variation likely reflects differences in perinatal and neonatal practice, systems (including inborn vs outborn care), and local attitudes toward provision of intensive care at the edge of viability.
– Identifying and studying these differences creates opportunity for targeted research, benchmarking, and policy work to improve outcomes and to inform parental counseling.