Proactive Management Promotes Outcome in Extremely Preterm Infants: A Population-Based Comparison of Two Perinatal Management Strategies

Abstract

In infants with a gestational age of 22 to 25 weeks, a proactive perinatal strategy increases the number of live births and improves the infant's postnatal condition and survival without evidence of increasing morbidity in survivors up to 1 year of age.

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

“…1,2 This decrease in mortality can be attributed to advances in peri-and neonatal care, such as regionalization, antenatal steroids, monitoring during labor, improved ventilation techniques, surfactant administration, and a positive attitude to intervention by the perinatal team. [2][3][4][5][6][7] However, large variability in the intensity of perinatal care and outcome of EPT infants is reported between centers, regions, and countries providing comparative levels of care. 6,[8][9][10][11][12][13][14] Proactive care, conceptualized as a policy of providing a high intensity of care for all EPT births, including those occurring at the edge of viability, 6,15 may decrease the rate of stillbirth [15][16][17] and increase survival of infants born alive.…”

“…[2][3][4][5][6][7] However, large variability in the intensity of perinatal care and outcome of EPT infants is reported between centers, regions, and countries providing comparative levels of care. 6,[8][9][10][11][12][13][14] Proactive care, conceptualized as a policy of providing a high intensity of care for all EPT births, including those occurring at the edge of viability, 6,15 may decrease the rate of stillbirth [15][16][17] and increase survival of infants born alive. 6,[12][13][14] Even so, there are concerns that active life support for vulnerable infants may increase the proportion of disabled survivors.…”

“…6,[8][9][10][11][12][13][14] Proactive care, conceptualized as a policy of providing a high intensity of care for all EPT births, including those occurring at the edge of viability, 6,15 may decrease the rate of stillbirth [15][16][17] and increase survival of infants born alive. 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. Few studies, however, have examined outcomes after explicitly proactive care, 6,15,26 and stillbirths are seldom included in outcome studies. There are concerns that intensive care is imposed on infants who ultimately die, 27 and the time to death for these infants has indeed increased.…”

Maternal and Perinatal Outcomes of Pregnancies Delivered at 23 Weeks’ Gestation

“…29,[40][41][42][43][44] Finally, a number of studies present data from populations that may differ from the Canadian population with respect to ethnicity and access to health care. 3,[7][8][9][10][11][12][13][14][16][17][18][19][20][21][22][23]34,45 Few studies have evaluated maternal outcomes of women delivering at a periviable gestation.…”