Variation of practice and poor outcomes for extremely low gestation births: ordained before birth?

Janvier, Annie; Baardsnes, Jason; Hebert, M.; Newell, Stephanie; Marlow, Neil

doi:10.1136/archdischild-2017-313332

Cited by 16 publications

(11 citation statements)

References 6 publications

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“…P reterm birth is difficult to predict and prevent. Although the long-term health outcomes for preterm infants have improved over time, extremely preterm birth has continued to be an issue in terms of optimal antenatal and postnatal management, [1][2][3][4][5] resource allocation and costs, 6 quality of care, 7 and long-term health outcomes. 8,9 Given these uncertainties, and compounded by changes in reproductive epidemiology, 10,11 it is important to evaluate international variations and time trends for the management and outcomes of extremely preterm birth.…”

mentioning

confidence: 99%

Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-2016

Norman

Hallberg

Abrahamsson

et al. 2019

JAMA

213

128

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mentioning

confidence: 99%

Association Between Year of Birth and 1-Year Survival Among Extremely Preterm Infants in Sweden During 2004-2007 and 2014-2016

Norman

Hallberg

Abrahamsson

et al. 2019

JAMA

213

128

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“…The attitudes of care providers towards the outcomes of babies born at the margins of viability were shown to influence the perinatal care of pregnancies at 22–24 weeks gestation and subsequent neonatal outcomes [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. These attitudes are however changing, as outcome data from recent publications suggest survival and outcome data for babies born at 22 weeks gestation—similar to what was achieved in the early 1990s with babies born at 24 weeks gestation [ 18 ].…”

Section: Historical Perspectivementioning

confidence: 99%

Gestation-Based Viability–Difficult Decisions with Far-Reaching Consequences

Thomas

Asztalos

2021

Children

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Most clinicians rely on outcome data based on completed weeks of gestational of fetal maturity for antenatal and postnatal counseling, especially for preterm infants born at the margins of viability. Contemporary estimation of gestational maturity, based on ultrasounds, relies on the use of first-trimester scans, which offer an accuracy of ±3–7 days, and depend on the timing of the scans and the measurements used in the calculations. Most published literature on the outcomes of babies born prematurely have reported on short- and long-term outcomes based on completed gestational weeks of fetal maturity at birth. These outcome data change significantly from one week to the next, especially around the margin of gestational viability. With a change in approach solely from decisions based on survival, to disability-free survival and long-term functional outcomes, the complexity of the parental and care provider’s decision-making in the perinatal and postnatal period for babies born at less than 25 weeks gestation remains challenging. While sustaining life following birth at the margins of viability remains our priority—identifying and mitigating risks associated with extremely preterm birth begins in the perinatal period. The challenge of supporting the normal maturation of these babies postnatally has far-reaching consequences and depends on our ability to sustain life while optimizing growth, nutrition, and the repair of organs compromised by the consequences of preterm birth. This article aims to explore the ethical and medical complexities of contemporary decision-making in the perinatal and postnatal periods. We identify gaps in our current knowledge of this topic and suggest areas for future research, while offering a perspective for future collaborative decision-making and care for babies born at the margins of viability.

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“…2 In fact, we simply don't know what the survival rate would be if resuscitation were offered or provided to all infants. 3 2 nonviability becomes a self-fulfilling prophecy. Alternatively, some centers or some countries change their policies, treat nonviable infants, and report better outcomes than are reported in many studies.…”

Section: Outcome Statistics Are Reportedmentioning

confidence: 99%