#3: Periviable Birth

Ecker, J.L.; Kaimal, A.; Mercer, Brian M.; Blackwell, Sean C.; deRegnier, Raye Ann; Farrell, Rhonda; Grobman, William A.; Resnik, Jamie L.; Sciscione, Anthony

doi:10.1097/01.aoa.0000504705.36064.75

Cited by 8 publications

(11 citation statements)

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“…24 Infants born at 20 weeks' gestation are too immature to survive, whereas, in many places, the majority of infants born at 25 weeks' gestation survive. Moreover, many hospitals, 25 professional societies, 26 and countries 27 have developed policies surrounding medical care on the basis of gestational age.…”

Section: Recommendation 3: Stratify Outcomes By Gestational Age At Birthmentioning

confidence: 99%

Reporting Outcomes of Extremely Preterm Births

et al. 2016

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Published reports of extremely preterm birth outcomes provide important information to families, clinicians, and others and are widely used to make clinical and policy decisions. Misreporting or misunderstanding of outcome reports may have significant consequences. This article presents 7 recommendations to improve reporting of extremely preterm birth outcomes in both the primary and secondary literature. The recommendations should facilitate clarity in communication about extremely preterm birth outcomes and increase the value of existing and future work in this area.

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Section: Recommendation 3: Stratify Outcomes By Gestational Age At Birthmentioning

confidence: 99%

Reporting Outcomes of Extremely Preterm Births

et al. 2016

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“…36 No. 5/2019 studies of deliveries at periviable gestational age are usually (but not always 2,3 ) restricted to live births 1,13,14. Based on our findings, we recommend that assessments and studies of deliveries at periviable gestation should incorporate both live births and stillbirths whenever possible.…”

mentioning

confidence: 79%

Stillbirth and Live Birth at Periviable Gestational Age: A Comparison of Prevalence and Risk Factors

et al. 2018

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“…18 The American College of Obstetricians and Gynecologists recommends a more conservative stepwise management plan to weigh maternal and fetal benefit. 19 However, more proactive practices on an institutional level have shown to improve outcomes for infants at the limit of viability. 20 Nonetheless, our findings suggest only a small percentage of institutions have a unified obstetrician-neonatologist support for proactive management of extremely premature infants.…”

Section: Discussionmentioning

confidence: 99%

Shifting Provider Attitudes and Institutional Resources Surrounding Resuscitation at the Limit of Gestational Viability

et al. 2020

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Objective This study aimed to provide contemporary data regarding provider perceptions of appropriate care for resuscitation and stabilization of periviable infants and institutional resources available to providers. Study Design A Qualtrics survey was emailed to 672 practicing neonatologists in the United States by use of public databases. Participants were asked about appropriate delivery room care for infants born at 22 to 26 weeks gestational age, factors affecting decision-making, and resources utilized regarding resuscitation. Descriptive statistics were used to analyze the dataset. Results In total, 180 responses were received, and 173 responses analyzed. Regarding preferred course of care based on gestational age, the proportion of respondents endorsing full resuscitation decreased with decreasing gestational age (25 weeks = 99%, 24 = 64%, 23 = 16%, and 22 = 4%). Deference to parental wishes correspondingly increased with decreasing gestational age (25 weeks = 1%, 24 = 35%, 23 = 82%, and 22 = 46%). Provision of comfort care was only endorsed at 22 to 23 weeks (23 weeks = 2%, 22 = 50%). Factors most impacting decision-making at 22 weeks gestational age included: outcomes based on population data (79%), parental wishes (65%), and quality of life measures (63%). Intubation with a 2.5-mm endotracheal tube (84%), surfactant administration in the delivery room (77%), and vascular access (69%) were the most supported therapies for initial stabilization. Availability of institutional resources varied; the most limited were obstetric support for cesarean delivery at the limit of viability (37%), 2.0-mm endotracheal tube (45%), small baby protocols (46%), and a consulting palliative care teams (54%). Conclusion There appears to be discordance in provider attitudes surrounding preferred actions at 23 and 22 weeks. Provider attitudes regarding decision-making at the limit of viability and identified resource limitations are nonuniform. Between-hospital variations in outcomes for periviable infants may be partly attributable to lack of provider consensus and nonuniform resource availability across institutions. Key Points

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#3: Periviable Birth

Cited by 8 publications

References 0 publications

Reporting Outcomes of Extremely Preterm Births

Reporting Outcomes of Extremely Preterm Births

Stillbirth and Live Birth at Periviable Gestational Age: A Comparison of Prevalence and Risk Factors

Shifting Provider Attitudes and Institutional Resources Surrounding Resuscitation at the Limit of Gestational Viability

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