Active care of infants born between 22 and 26 weeks of gestation does not follow consensus expert recommendations

Abstract

Aim To determine the relationship between clinical practice and publication of an Australian consensus statement for management of extremely preterm infants in 2006. Methods A population‐based study using linked data from New South Wales, Australia for births between 22 + 0 and 26 + 6 weeks of gestation between 2000 and 2011. Results There were 4746 births of whom 2870 were liveborn and 1876 were stillborn. Of the live births, 2041 (71%) were resuscitated, 1914 (67%) were admitted into a neonatal intensive care unit (NICU) and 1310 (46%) survived to hospital discharge. Thirty‐nine (2%) stillbirths were resuscitated but none survived. No 22‐week infant survived to hospital discharge. Fewer 23‐week gestation infants were resuscitated between 2004 (52%) and 2005 (20%) but resuscitation rates increased by 2008 (44%). There was no difference at other gestations. Adjusted odds ratio (OR) for resuscitation was increased by birthweight (OR: 1.01), tertiary hospital birth (OR: 3.4) and Caesarean delivery (OR: 11.3) and decreased by rural residence (OR: 0.4) and male gender (OR: 0.7). Conclusion Expert recommendations may be shaped by clinical practice rather than the converse, especially for 23‐week gestation infants. Recommendations should be revised regularly to include clinical practice changes.

More studies are needed to convince stakeholders of the value of resuscitating periviable infants

“…Overall, the outcome of preterm infants born in Australia has been maintained at a high level, as shown by Sinclair et al. . Once the resuscitation rate increased, this led to dramatic improvements in the survival rate.…”

“…As Sinclair et al. stated in their paper, 99% of their subjects died if they did not receive any form of active resuscitation. Guidelines that state that resuscitation should not be started at a specific gestational age cannot be adapted in a timely manner, because the outcomes of these periviable preterm infants are rapidly changing.…”

“…In this issue of Acta Paediatrica, Sinclair et al. describe the relationship between the publication of an Australian expert consensus statement on resuscitating preterm infants born before 26 weeks of gestation and their short‐term outcomes. The authors found that the statement, which was published in 2006, had minimal impact on the clinical practices of neonatologists in delivery rooms.…”

Negativity about the outcomes of extreme prematurity a persistent problem - a survey of health care professionals across the North Queensland region

“…Most guidelines currently in use in Australia, include parental discretion around the resuscitation of babies below 24 or 25 weeks gestation [3,4,39]. Despite the negativity of clinicians and guidelines discouraging the resuscitation of babies under 24 weeks, many of these babies are receiving intensive care in Australia and a recent review of the use of the consensus guidelines in New South Wales and Australian Capital Territory reflect that resuscitation at 23 and even 22 weeks regularly occurs [40]. In North Queensland, nearly all babies at 24 weeks gestation and nearly half of babies delivered at 23 weeks gestation receive tertiary intensive care, regardless of place of delivery [10].…”

Highlights in this issue

“…Sinclair et al. evaluated the relationship between the publication of an Australian expert consensus statement on resuscitating preterm infants born between 22 and 26 weeks of gestation and their short‐term outcomes. They found that the statement, which was published in 2006, was frequently not followed in clinical practice.…”