Survival of Infants Born at Periviable Gestational Ages

Patel, Ravi; Rysavy, Matthew A.; Bell, Edward F.; Tyson, Jon E.

doi:10.1016/j.clp.2017.01.009

Cited by 119 publications

(82 citation statements)

References 83 publications

(99 reference statements)

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“…Of those who survive, about one third have moderate to severe disability . But these statistics vary depending on the skill of the NICU staff, the technology available, the gender of the child, the weight, the exact gestation, the in utero environment, the genetic make‐up, and the list goes on . And to be honest, when you are experiencing the rare event of severe preeclampsia early in pregnancy, statistics mean very little.…”

Section: Difficult Decision‐makingmentioning

confidence: 99%

‘Whatever decision you make it will be the right one’: A parent's reflection on difficult decision‐making in premature birth

O’Neill

2019

J Paediatrics Child Health

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In 2007, our daughter Lily was born prematurely. My husband and I were faced with a very difficult decision about the level of intervention for her, a decision that had to be made in an emergency situation under the pressure of time. As a paediatric nurse I had more knowledge about prematurity than most parents, and it was certainly enough to appreciate the fragility of babies born early, and their uncertain and often complicated path through neonatal intensive care. What I didn't fully appreciate was the key role of health professionals, not only in providing care, but in supporting difficult decision-making. In the years since Lily's birth I've also reflected on the power of health professionals to shape, or reshape, the narrative of premature birth which is pivotal in the long-term psychological trajectory of parents.

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Section: Difficult Decision‐makingmentioning

confidence: 99%

‘Whatever decision you make it will be the right one’: A parent's reflection on difficult decision‐making in premature birth

O’Neill

2019

J Paediatrics Child Health

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“…In total, 74% (222/302) of 22–24‐week live births were admitted to the NICU in WA in 2004–2010, a higher overall rate than comparable local and international cohorts. In 2017, Patel and colleagues published a review comparing active management and survival rates of periviable live births in developed nations . Table reports NICU admission rates in the WA cohort compared with four population‐based cohorts in Patel's review.…”

Section: Neonatal Intensive Care Unit Admission Rates Following Live mentioning

confidence: 99%

“…1 Obtaining information about outcomes following active intervention is challenging because of an inconsistent approach to the management of births at 22-24 weeks' gestation across Australia and internationally. [2][3][4] In some centres, infants born at 22 weeks' gestation are being offered neonatal intensive care. 2,5 Yet in other centres, neonatal intensive care admission is still discouraged below 24 weeks' gestation, and provision of intensive care at 24 weeks is considered optional.…”

mentioning

confidence: 99%

“…In 2017, Patel and colleagues published a review comparing active management and survival rates of periviable live births in developed nations. 4 Table 1 reports NICU admission rates in the WA cohort compared with four population-based cohorts in Patel's review. These data highlight both the wide variation in approach to management of these infants and the proactive approach to care taken in the WA cohort, with 81% (78/96) of live births admitted to the NICU at 23 weeks and 95% (139/146) at 24 weeks' gestation.…”

mentioning

confidence: 99%

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Neonatal intensive care at 22–24 weeks’ gestation: How low should we go?

Boland

Bowen

2017

J Paediatrics Child Health

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“…However, studies in human pregnancies did not confirm significant alterations in uterine blood flow. 13,14 …”

Section: 11mentioning

confidence: 99%

Assessment of Maternal Nifedipine as a Tocolytic Agent on the Doppler Indices of Uterine and Fetal Umbilical and Middle Cerebral Arteries

Abdellateef¹,

Shorbagy²,

Hagras³

et al. 2017

Gynecol Obstet Res Open J

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CitationAbdellateef SS, El Shorbagy SH, Hagras AM, Ghareeb AE. Assessment of maternal nifedipine as a tocolytic agent on the Doppler indices of uterine and fetal umbilical and middle cerebral arteries. This study was designed to assess the effects of maternal nifedipine administration on blood flow resistance in uterine, umbilical and fetal middle cerebral arteries by evaluating resistance index (RI) and pulsatility index (PI). Patients and Methods: This was a prospective, observational, analytic cohort study performed in 50 pregnant women undergoing nifedipine tocolysis, all women with a singleton pregnancy between 24 and 34 weeks of gestation, each subject acting as her own control. Doppler assessment of uterine, umbilical and fetal middle cerebral (MCA) arteries was performed before and 24 h and 72 h after an initial 20 mg oral dose, which was repeated at 20 min intervals if contractions failed to diminish up to a total maximum dose of 60 mg. The maintenance dose consisted of 20 mg orally every 6 h. We analyzed whether there was a time effect and compared values at the different time-points. Results: The research showed that the UtA-RI has increased significantly after 24 h and after 72 h of nifedipine administration (0 h=0.53; 24 h=0.56; 72 h=0.55; p=0.002, p=0.015 respectively). The MCA-RI had decreased significantly after 24 h (p=0.003) of tocolysis returning to baseline after 72 h (0 h=0.75; 24 h=0.73; 72 h=0.74; p=0.150). The MCA-PI had decreased significantly after 24 h (P=0.024) of tocolysis returning to baseline between 24 h and 72 h (0 h=1.85; 24 h=1.75; 72 h=1.79; p=0.204), with no differences in UtA-PI or in the umbilical arteries Doppler (RI & PI) or in the MCA to umbilical artery ratio. Conclusions: Nifedipine tocolysis is associated with a reduction in RI and PI in the MCA, and an increase in RI in uterine arteries after 24 h but returning to baseline within 72 h, with no long-term effect on fetomaternal circulation in pregnant women at risk of preterm delivery.

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Survival of Infants Born at Periviable Gestational Ages

Cited by 119 publications

References 83 publications

‘Whatever decision you make it will be the right one’: A parent's reflection on difficult decision‐making in premature birth

‘Whatever decision you make it will be the right one’: A parent's reflection on difficult decision‐making in premature birth

Neonatal intensive care at 22–24 weeks’ gestation: How low should we go?

Assessment of Maternal Nifedipine as a Tocolytic Agent on the Doppler Indices of Uterine and Fetal Umbilical and Middle Cerebral Arteries

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