We Know Less Than We Think We Know About Perinatal Outcomes

Lantos, John D.

doi:10.1542/peds.2018-1223

Cited by 12 publications

(8 citation statements)

References 8 publications

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“…As the analysis focused on liveborn infants who received postnatal life support, we do not know the quantity of pregnancies that had outcomes of termination, intrauterine fetal demise, or stillbirth, and any association with ANS receipt or nonintervention. 2 , 61 …”

Section: Discussionmentioning

confidence: 99%

Association of Antenatal Steroid Exposure With Survival Among Infants Receiving Postnatal Life Support at 22 to 25 Weeks’ Gestation

et al. 2018

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Key Points Question For infants born at the edge of viability who received postnatal life support, was the administration of antenatal steroids associated with higher rates of survival? Finding In a cohort study of 33 472 infants born at 22 to 25 weeks’ gestation between 2012 and 2016, the concordant receipt of antenatal steroids and postnatal life support was significantly associated with higher rates of survival compared with postnatal life support alone. Meaning There is an opportunity for reevaluation of national guidelines, allowing for shared decision making with concordant obstetrical and neonatal treatment plans.

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Section: Discussionmentioning

confidence: 99%

Association of Antenatal Steroid Exposure With Survival Among Infants Receiving Postnatal Life Support at 22 to 25 Weeks’ Gestation

et al. 2018

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“…Case selection also occurs antenatally [ 10 ]. It has therefore been proposed that a ‘foetuses-at-risk’ approach should be adopted to minimise potential bias [ 11 – 13 ]. Evidence regarding the influence of intensity of perinatal care—that is, the degree to which women who deliver extremely preterm and their offspring receive ‘active’ management—on survival and morbidity outcomes is limited: only one study has examined this question.…”

Section: Introductionmentioning

confidence: 99%

Intensity of perinatal care, extreme prematurity and sensorimotor outcome at 2 years corrected age: evidence from the EPIPAGE-2 cohort study

Morgan

L’Hélias

Diguisto

et al. 2018

BMC Med

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BackgroundEmerging evidence suggests intensity of perinatal care influences survival for extremely preterm babies. We evaluated the effect of differences in perinatal care intensity between centres on sensorimotor morbidity at 2 years of age. We hypothesised that hospitals with a higher intensity of perinatal care would have improved survival without increased disability.MethodsFoetuses alive at maternal admission to a level 3 hospital in France in 2011, subsequently delivered between 22 and 26 weeks gestational age (GA) and included in the EPIPAGE-2 national prospective observational cohort study formed the baseline population. Level of intensity of perinatal care was assigned according to hospital of birth, categorised into three groups using ‘perinatal intensity’ ratios (ratio of 24–25 weeks GA babies admitted to neonatal intensive care to foetuses of the same GA alive at maternal admission to hospital). Multiple imputation was used to account for missing data; hierarchical logistic regression accounting for births nested within centres was then performed.ResultsOne thousand one hundred twelve foetuses were included; 473 survived to 2 years of age (126 of 358 in low-intensity, 140 of 380 in medium-intensity and 207 of 374 in high-intensity hospitals). There were no differences in disability (adjusted odds ratios 0.93 (95% CI 0.28 to 3.04) and 1.04 (95% CI 0.34 to 3.14) in medium- and high- compared to low-intensity hospitals, respectively). Compared to low-intensity hospitals, survival without sensorimotor disability was increased in the population of foetuses alive at maternal admission to hospital and in live-born babies, but there were no differences when considering only babies admitted to NICU or survivors.ConclusionsNo difference in sensorimotor outcome for survivors of extremely preterm birth at 2 years of age was found according to the intensity of perinatal care provision. Active management of periviable births was associated with increased survival without sensorimotor disability.Electronic supplementary materialThe online version of this article (10.1186/s12916-018-1206-4) contains supplementary material, which is available to authorized users.

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“…Understanding the outcomes of infants with extreme prematurity is also complicated by the use of datasets that include infants who did not receive intensive intervention at delivery, driving down reported survival rates. 11 More concerning and less understandable is the wide variation that occurs within similar high-resource locales in terms of resuscitation at delivery. 12 Although broad guidelines as previously outlined exist, adherence to such guidelines varies.…”

Section: Approaches To Treatment Options At Delivery For Infants With Extreme Prematurity Remain Inconsistentmentioning

confidence: 99%

Perinatal Counseling at the Margin of Gestational Viability: Where We’ve Been, Where We’re Going, and How to Navigate a Path Forward

Arnolds

Laventhal

2021

The Journal of Pediatrics

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We Know Less Than We Think We Know About Perinatal Outcomes

Abstract: Most of what we think we know about survival rates for infants born at 22 or 23 weeks' gestational age is probably wrong. It is wrong because of some well-recognized but oddly persistent quirks in the ways that outcome data are collected and reported. Here are some of those quirks:

Cited by 12 publications

References 8 publications

Association of Antenatal Steroid Exposure With Survival Among Infants Receiving Postnatal Life Support at 22 to 25 Weeks’ Gestation

Association of Antenatal Steroid Exposure With Survival Among Infants Receiving Postnatal Life Support at 22 to 25 Weeks’ Gestation

Intensity of perinatal care, extreme prematurity and sensorimotor outcome at 2 years corrected age: evidence from the EPIPAGE-2 cohort study

Perinatal Counseling at the Margin of Gestational Viability: Where We’ve Been, Where We’re Going, and How to Navigate a Path Forward

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