Frühgeborene an der Grenze der Lebensfähigkeit

Bührer, Christoph; Felderhoff-Müser, Ursula; Kribs, Angela; Roll, Charles Robert; Völkner, A.; Gembruch, Ulrich; Hecher, Kurt; Kainer, Franz; Maier, Russell; Vetter, K.; Krones, Tanja; Lipp, Volker; Steppat, Susanne; Wirthl, H.-J.

doi:10.1055/s-0034-1395575

Cited by 13 publications

(4 citation statements)

References 71 publications

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“…Only surgical treatment (laser or cryotherapy) was reg-istered until 2015 but not intravitreal injections which already outnumbered surgical treatment when first registered in 2016. We restricted the analysis to infants born between 24 weeks 0 days and 27 weeks 6 days of gestation, as resuscitation of infants below 24 weeks is optional in Germany, without any change during the 8-year observation period [28]. Epi Info 7.2 (Centers for Disease Control and Prevention, Atlanta, GA, USA) was employed to compare proportions using Fisher exact test, to compute RRs with 95% confidence intervals (CIs), and to calculate extended Mantel-Haenszel Chi-square (χ 2 ) for linear trend statistics, with p values below 0.05 considered significant.…”

Section: Methodsmentioning

confidence: 99%

Population-Based Outcome Data of Extremely Preterm Infants in Germany during 2010–2017

2022

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Background and Objective: Results of five randomized controlled trials (RCT) sequentially published in 2010–2013 suggested that aiming for higher, as opposed to lower oxygen saturation targets, reduces rates of mortality in infants <28 weeks of gestation, while increasing rates of severe retinopathy of prematurity (ROP). Two further RCTs published in 2011 and 2015 demonstrated that avoiding endotracheal intubation by minimally invasive surfactant administration reduces respiratory morbidity. Assuming that such data are likely to affect clinical practice and ultimate outcome, we analyzed population-level results in extremely preterm infants born across Germany during 2010–2017. Methods: We used mandatory German quality surveillance data to compare mortality and morbidities in preterm infants born between 24 weeks 0 days and 27 weeks 6 days of gestation in 2010–2013 versus 2014–2017. Results: Mortality decreased from 15.1% (1,366/9,058) in 2010–2013 to 12.7% (1,385/10,924) in 2014–2017, risk ratio (RR) 0.845 (95% confidence interval [CI], 0.784–0.901). Rates of severe ROP (≥grade 3) per survivor increased from 12.1% (930/7,692) to 13.3% (1.269/9,539), RR 1.100 (95% CI: 1.017–1.191). The lowest mortality and highest ROP rates were found in infants born in 2014. There was no change in rates of necrotizing enterocolitis, while those of bronchopulmonary dysplasia (BPD) decreased steadily between 2010 and 2017, alongside the increased proportion of infants who were never intubated. Conclusions: There was a moderate decline in mortality, an insignificant increase in severe ROP, and a steady decline of BPD in Germany during 2010–2017. Avoiding endotracheal intubation may have contributed to lowered BPD rates.

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Section: Methodsmentioning

confidence: 99%

Population-Based Outcome Data of Extremely Preterm Infants in Germany during 2010–2017

2022

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“…Die Leitlinie plädiert "für eine im Kern einwöchige Grauzone (23 0 /7 bis 23 6 /7 Wochen)" "mit Erweiterung nach oben und unten unter Einbeziehung des Gewichtes". Bei der Entscheidung seien letztlich die elterlichen Wertvorstellungen ausschlaggebend, und eine auf Lebensverlängerung zielende Behandlung von Frühgeborenen im Grenzbereich sei vertretbar, wenn sie in entsprechend qualifizierten Perinatalzentren auf ausdrücklichen Wunsch der Eltern nach ausführlicher interdisziplinärer Beratung erfolge [1].…”

Section: Kommentarunclassified

“…Nach der noch bis 2025 gültigen AWMF-Leitlinie "Frühgeborene an der Grenze der Lebensfähigkeit" [1] befinden wir uns bei der Beurteilung der Lebensaussichten bei einem Geburtsgewicht ≥ 400 g im Gestationsalter 22 + 0 bis 23 + 6 in einem Graubereich, in dem valide Aussage zu einem Langzeitverlauf nicht möglich sind. Für Neugeborene mit einem Geburtsgewicht < 400 g beträgt dieser Bereich 23 + 0 bis 24 + 6 Wochen.…”

Section: Kommentarunclassified

Schwedisches Management steigert Überleben sehr unreifer Frühgeborener

2024

Neonatologie Scan

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“…But medical recommendations to offer therapy highly differ between different countries and do not necessarily reflect the complexity of the prognosis. They are mainly available for the industrialized world and some countries like Argentina, while in resource-limited countries differences and restraints in technical and personal equipment impose the establishment of general rules and recommendations (2, 24–26). If there is no medical indication for therapy due to severe diseases, this must be stated by the treating physicians as a matter of fact.…”

Section: Ethical and Legal Considerations In The Decision Processmentioning

confidence: 99%