Developmental Outcome of Extremely Preterm Infants

Abstract

Institution-based studies from perinatal centers are reporting encouraging survival and developmental outcome in extremely preterm infants, but population-based studies of all such births within a geographical-defined region are necessary to examine the impact of perinatal-neonatal care on the entire community. We have reported that their perinatal mortality and severe disability rate were significantly lower in those born within perinatal centers compared with those born elsewhere. Promotion of "in utero transfer" is associated with a significant improvement in their survival and developmental outcome. Postnatal surfactant therapy, which began a decade ago, saw a doubling of the survival rate for infants born as early as 24-26 weeks, while their severe disability rate remains below 10%. Although surfactant and mechanical ventilation are expensive therapies, the resulting improvement in outcome was responsible for a reduction in the cost per additional quality-adjusted life-year gained.

Proactive Management Promotes Outcome in Extremely Preterm Infants: A Population-Based Comparison of Two Perinatal Management Strategies

“…Centralized management of extremely premature birth is a cornerstone of proactive management. 18 In pregnancies of Ͻ26 weeks' duration, the differences between North and South were conspicuous. In the North during period 3, only ϳ15% of women with extremely preterm birth before 26 weeks' GA were delivered outside a level III unit.…”

Attitudes of Level II obstetricians towards the care of the extremely premature infant: A national survey

“…Most data on the prevalence of major sensorineural and developmental disability among extremely preterm infants are populationbased and vary between regions. 5,10,[15][16][17][18][19][20] For example, recently published data showed severe disability for children at 5 years of age in Victoria was 20% (23-27 weeks' gestation cohort) and 29% (23-25 weeks' gestation cohort). 17 Hack and Fanaroff reported that 34% of survivors at 23 weeks gestation were severely disabled while rates for 24 weeks ranged from 22 to 45% and at 25 weeks, from 12 to 35%.…”

“…The clinical management of labour and delivery may depend on the health‐care professional's perception, knowledge and attitude towards the fetus’ potential for survival 1,2 and indeed, some studies have found that misconceptions regarding outcome of such pregnancies may result in suboptimal care 1−4 . Compared to outborn infants, rates of perinatal mortality and severe disability have been found to be significantly lower in infants born within perinatal centres 5 . There are, however, a considerable number of preterm infants born in hospitals without advanced perinatal facilities 6−8 , and it is inevitable that in a vast country like Australia, many preterm pregnancies will initially present to non‐tertiary centres.…”

“…[1][2][3][4] Compared to outborn infants, rates of perinatal mortality and severe disability have been found to be significantly lower in infants born within perinatal centres. 5 There are, however, a considerable number of preterm infants born in hospitals without advanced perinatal facilities, [6][7][8] and it is inevitable that in a vast country like Australia, many preterm pregnancies will initially present to non-tertiary centres. This survey was conducted to explore the opinions of non-tertiary obstetricians towards the care and outcome of extremely preterm infants.…”

Dificuldade de aprendizagem em escolares de muito baixo peso ao nascer

“…1 A significant part of this reduction is the result of reductions in neonatal mortality brought about by pharmacological and technical advances, both in delivery rooms and intensive care units. [2][3][4][5][6][7][8][9][10][11][12] Exogenous surfactant treatment has been particularly decisive to the survival of neonates with very low birth weights (below 1,500 g) and extremely low birth weights (below 1,000 g). 13 According to the literature on this subject, these babies are at increased risk of sequelae such as cerebral palsy, intellectual deterioration and convulsions, 14 in addition to blindness and deafness.…”