Obstetric interventions for babies born before 28 weeks of gestation in Europe: results of the MOSAIC study

Abstract

Objective To describe obstetric intervention for extremely preterm births in ten European regions and assess its impact on mortality and short term morbidity.Design Prospective observational cohort study. Main outcome measures Use of antenatal corticosteroids, antenatal transfer and caesarean section by two-week gestational age groups as well as a composite score of these three interventions. Outcomes included stillbirth, in-hospital mortality and intraventricular haemorrhage (IVH) grades III and IV and/or periventricular leucomalacia (PVL) and bronchopulmonary dysplasia (BPD).Results There were large differences between regions in interventions for births at 22-23 and 24-25 weeks. Differences were most pronounced at 24-25 weeks; in some regions these babies received the same care as babies of 28-29 weeks, whereas elsewhere levels of intervention were distinctly lower. Before 26 weeks and especially at 24-25 weeks, there was an association between the composite intervention score and mortality. No association was observed at 26-27 weeks. For survivors at 24-25 weeks, the intervention score was associated with higher rates of BPD, but not with IVH or PVL.Conclusions There are large differences between European regions in obstetric practices at the lower limit of viability and these are related to outcome, especially at 24-25 weeks.

Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists

“…However, defining proactive obstetrical management as the administration of antenatal steroids and/or performance of a Cesarean section is consistent with the literature about obstetrical perinatal care at the threshold of viability. 3,13,26 Despite these limitations, this study followed a large cohort of extremely premature infants with consistent prospective data collection. The results show the impact of both antenatal steroids and Cesarean section together with neonatal resuscitation at birth on infant survival within the first 24 h. Appropriate decision-making at the threshold of viability requires constant communication between obstetricians and neonatologists to ensure the best outcomes for infants and their families.…”

Impact of Fetal Weight Estimation on the Prediction of Neonatal Morbidity and Mortality at the Limit of Viability

“…Chances of survival were significantly higher in the underestimated group for birth weight at delivery compared with estimated weight ( p < 0.001), with risk of death being significantly lower ( p < 0.001). The reverse was true for overestimated infants, ment for infants born at the limit of viability varies, especially at 24-25 weeks of gestation, showing that Poland, Germany, and Portugal favor an active management already at a GA below 23 weeks [4] . On the other hand, aggressive intervention starting at a GA of 23 0 / 7 weeks is recommended in the USA [5] .…”

Unterschiede der Behandlungsgrenzen in Europa

“…Verschiedene Studien (z. B. EPICU-RE-Studie oder MOSAIC-Studie; [9,16]) innerhalb Europas beschäftigen sich nicht nur mit der Überlebensrate, sondern auch mit der Kurz-und Langzeitentwicklung der Kinder mit extremer Frühgeburt. Diese Studien zeigen, dass bisher kein Kind, das vor der 22.…”

“…1). Wie in der MOSAICStudie bereits gezeigt, bestehen die größ-ten Unterschiede zwischen den Richtlinien und Vorgehensweisen von Deutschland und Italien auf der einen und den Niederlanden sowie der Schweiz auf der anderen Seite [16]. Im übertragenen Sinne stehen sich eine vorwiegend katholische Moraltheorie mit dem Ziel der Lebenserhaltung um jeden Preis und eine calvinistisch pragmatische, beinahe darwinistische Lebenseinstellung mit dem Ziel der Vermeidung von Leben mit schwerer Behinderung gegenüber.…”