Comparison of Management Strategies for Extreme Prematurity in New Jersey and the Netherlands: Outcomes and Resource Expenditure

Lorenz, John M.; Paneth, Nigel; Jetton, James; Ouden, Lya den; Tyson, Jon E.

doi:10.1542/peds.108.6.1269

Cited by 116 publications

(73 citation statements)

References 45 publications

(24 reference statements)

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“…6,[12][13][14] Even so, there are concerns that active life support for vulnerable infants may increase the proportion of disabled survivors. 18,19 The obstetrician's willingness to intervene on fetal behalf was associated with lower stillbirth rates and improved survival in infants weighing ,1000 g but was also associated with major neonatal morbidity. 16 Approximately 25% of EPT infants born in the 1990s had a major neurodevelopmental disability at preschool age 20 ; since then, decreasing, 21 unchanged, 22,23 or increasing 19,24,25 rates of neurodevelopmental impairment (NDI) have been reported.…”

Section: What This Study Addsmentioning

confidence: 99%

Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years

et al. 2015

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, for the EXPRESS Study Group abstract OBJECTIVE: To examine the association between intensity of perinatal care and outcome at 2.5 years' corrected age (CA) in extremely preterm (EPT) infants (,27 weeks) born in Sweden during 2004-2007. METHODS: A national prospective study in 844 fetuses who were alive at the mother's admission for delivery: 707 were live born, 137 were stillborn. Infants were assigned a perinatal activity score on the basis of the intensity of care (rates of key perinatal interventions) in the infant's region of birth. Scores were calculated separately for each gestational week (gestational age [GA]-specific scores) and for the aggregated cohort (aggregated activity scores). Primary outcomes were 1-year mortality and death or neurodevelopmental disability (NDI) at 2.5 years' CA in fetuses who were alive at the mother's admission. In health care regions with higher aggregated activity scores, the risk of death or NDI at 2.5 years' CA was reduced in the primary population (aOR: 0.69; 95% CI: 0.50-0.96) and in live-born infants (aOR: 0.68; 95% CI: 0.48-0.95). Risk reductions were confined to the 22-to 24-week group. There was no difference in NDI risk between survivors at 2.5 years' CA.CONCLUSIONS: Proactive perinatal care decreased mortality without increasing the risk of NDI at 2.5 years' CA in EPT infants. A proactive approach based on optimistic expectations of a favorable outcome is justified.

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Section: What This Study Addsmentioning

confidence: 99%

Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years

et al. 2015

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“…35 Although markers of major neonatal morbidity are well-known antecedents of later disability in childhood, in-hospital morbidity is not equivalent to childhood disability. In current published literature, rates of severe disability vary between 17% and 45% for those who are born at 24 weeks of gestation and between 12% and 35% at 25 weeks.…”

Section: Figmentioning

confidence: 99%

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

Vanhaesebrouck

Allegaert²,

Bottu³

et al. 2004

Pediatrics

182

123

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ABSTRACT. Objective. To determine mortality and morbidity at discharge from the hospital of a large population-based cohort of infants who were born at <26 weeks' gestation.Methods. Perinatal data were collected on extremely preterm infants who were alive at the onset of labor and born between January 1, 1999, and December 31, 2000, in all 19 Belgian perinatal centers.Results. A total of 525 infants were recorded. Lifesupporting care was provided to 322 liveborn infants, 303 of whom were admitted for intensive care. The overall survival rate of liveborn infants was 54%. Of the infants who were alive at the age of 7 days, 82% survived to discharge. Vaginal delivery, shorter gestation, air leak, longer ventilator dependence, and higher initial oxygen need all were independently associated with death; gender, plurality, and surfactant therapy were not. Among the 175 survivors, 63% had 1 or more of the 3 major adverse outcome variables at the time of discharge (serious neuromorbidity, chronic lung disease at 36 weeks' postmenstrual age, or treated retinopathy of prematurity). The chance of survival free from serious neonatal morbidity at the time of hospital discharge was <15% (21 of 158) for the admitted infants with a gestation <26 weeks.Conclusions. If for the time being prolongation of pregnancy is unsuccessful, then outcome perspectives should be discussed and treatment options including nonintervention explicitly be made available to parents of infants of <26 weeks' gestation within the limits of medical feasibility and appropriateness. Pediatrics 2004; 114:663-675; extreme prematurity, mortality, morbidity, population-based cohort.

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“…Several studies have indicated that 'sanctity of life' and 'treat until certainty' rather than 'quality of life' is the prevailing principle in the United States and eastern European countries whereas decisions considering 'quality of life' are more prevalent in western Europe. [1][2][3][4] A conservative attitude advocating 'sanctity of life' is commonly held by communities with a strong religious affiliation, more so among Catholics than Protestants, and less by seculars. Cultural background, personal experience and education are also relevant.…”

Section: Introductionmentioning

confidence: 99%

“…3,4 The impact of countries' strategies for treatment on the outcome of very premature infants has been recently studied comparing New Jersey and the Netherlands. 2 A conservative attitude in applying life-sustaining measures in the United States resulted in doubling the percentage of survivors, but also in higher prevalence of disabling cerebral palsy. 2 It is generally agreed that end-of-life decisions should be worked out together by both the family and the medical staff caring for the infant.…”

Section: Introductionmentioning

confidence: 99%

Parental religious affiliation and survival of premature infants with severe intraventricular hemorrhage

2008

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Objective: To evaluate the association between parents' ethnic/religious affiliation (secular Jewish, religious Jewish, ultra-orthodox Jewish, Muslim Arabs) and survival of premature infants with severe intraventricular hemorrhage (IVH).Study Design: Survival of 102 infants (birth weightp1500 g) born at the Hadassah hospitals in Jerusalem from 1 January 1996 through 31 December 2005, who sustained severe IVH and who survived over 48 h, was assessed in relation to their parents' ethnic/religious affiliation and accounting for relevant clinical and demographic variables.Result: There were 38 cases of demise among 72 infants with IVH grade IV (52.8%), and 4 among 30 infants with IVH grade III (13.3%). In a multivariate logistic regression analysis accounting for relevant perinatal variables, the odds for mortality compared to the reference Arab group was significantly lower only with regard to ultra-orthodox patients (odds ratio, OR ¼ 0.06; 95% confidential interval, CI ¼ 0.00 to 0.80; P ¼ 0.033). In a logistic and in the Cox stepwise regression analyses with religion as forced in variable, comparing infants with IVH grade IV of religious and ultraorthodox Jewish families with those of secular Jewish families, the OR/ hazard ratio (HR) for mortality were OR ¼ 0.10; 95% CI ¼ 0.01 to 0.06; P ¼ 0.017, and HR ¼ 0.37; 95% CI ¼ 0.16 to 0.85; P ¼ 0.019, respectively. No significant difference between the groups was demonstrated when infants with IVH grade III were analyzed apart.Conclusion: Parental religious affiliation may be influential on the outcome of premature infants with severe brain damage.

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Comparison of Management Strategies for Extreme Prematurity in New Jersey and the Netherlands: Outcomes and Resource Expenditure

Cited by 116 publications

References 45 publications

Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years

Intensity of Perinatal Care for Extremely Preterm Infants: Outcomes at 2.5 Years

The EPIBEL Study: Outcomes to Discharge From Hospital for Extremely Preterm Infants in Belgium

Parental religious affiliation and survival of premature infants with severe intraventricular hemorrhage

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