Improved Outcome of Infants Born at less than 24 Weeks of Gestation in Japan

Nishida, Hiroshi

doi:10.4172/2157-7420.s11-001

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…12 Nishida performed sequential evaluations of neonates born at 23 weeks' gestation or less in 1995 to 2001 and found that for categories < 300, 300 to 399, and 400 to 499 g, survival rates were 10, 17, and 47%, respectively, and severe impairment rates were 100, 47, and 39%, respectively. 13 Qiu et al reported an increased risk of mortality, morbidities, and resource utilization among SGA infants compared with non-SGA infants of similar GA, similar to our data. 14 Maternal hypertension was common (46%) in our cohort and the majority of neonates were delivered operatively.…”

Section: Discussionsupporting

confidence: 91%

Survival, Short-Term, and Long-Term Morbidities of Neonates with Birth Weight < 500 g

et al. 2017

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Objectives The objective of this study was to describe survival, short-term, and long-term morbidities of neonates with birth weight < 500 g. Study Design Retrospective cohort studies to calculate survival, short-term, and long-term morbidity rates of neonates born weighing < 500 g from 1993 to 2012 and neurodevelopmental impairment rates at 4.5 years for births 1993 to 2008 in one center. Results Of 549 inborn neonates with birth weight < 500 g, 4% survived. For live births and neonatal intensive care unit (NICU) admissions, 10 and 55% survived, respectively. Of 28 NICU (inborn and outborn) survivors (median birth weight 460 g and gestation 25.9 weeks [range: 22.6–30.3 weeks]), 71% were inborn, 50% male, and 75% were small for gestational age. One in five neonates was a twin or multiple. Short-term morbidities noted were bronchopulmonary dysplasia (91%), culture proven sepsis (50%), retinopathy of prematurity (41%), and severe brain injury (22%); 27% had no long-term impairment, 23% one, 23% two, 18% three, and 9% four impairments in motor, cognitive, vision, and/or hearing domains. At 4.5 years, 29% had visual impairment, 10% wore hearing aids, 50% had IQ < 70, 18% cerebral palsy, and 68% had low motor scores. Conclusion Only 4% of births < 500 g survived. All survivors had short-term morbidities; 27% neonates survived without long-term major impairments.

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Section: Discussionsupporting

confidence: 91%

Survival, Short-Term, and Long-Term Morbidities of Neonates with Birth Weight < 500 g

et al. 2017

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“…In Japan, for instance, they are investing many resources to improve the survival rate of the newborns born between the 22 and 23 weeks of gestation, although the knowledge and the medical technologies are limited for the care of these neonates and on the long-term outcomes [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

The child with medical complexity

et al. 2021

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Children with medical complexity represent a big challenge for the physicians, their families and the society as well. Although there is no clear definition of this type of patients, they are affected by a chronic, often very severe condition for their whole life. They also represent a huge cost for the health care system due to their needs of continuous assistance.In this review we summarized the definitions of child with medical complexity. Then we illustrated the strategies to treat and take care of these children in order to look at them not as a burden or a cost but as an opportunity to growth and improve as clinicians and to improve the society, to give them the best life they can live.We also wanted to give voice to the physicians, the parents and the children themselves to really show and understand what are their experiences and their feelings in dealing with their conditions. We concluded with the description of one example of children with medical complexity: prematurity. We discussed the progresses in their treatment so far in order to illustrate what is the future of pediatrics. Since it has been more and more acknowledged that every child with medical complexity is unique, the future of pediatric is to organize an individualized approach and to “see things with the eye of a child”.

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“…1 In Japan and parts of Sweden, on the other hand, an approach of universal resuscitation is favored for neonates delivered at 22 weeks of gestation, and these countries report higher survival rates. 22,23 Moreover, Japan reports improved neurodevelopmental outcomes at this periviable age. 24 Both of these countries, nonetheless, have different cultural values, health care systems, and parental support, both prenatally and postnatally, so their improved outcomes may not be generalizable to other countries.…”

Section: Discussionmentioning

confidence: 99%

Cost Effectiveness of Neonatal Resuscitation at 22 Weeks of Gestation

Yieh

Dukhovny

Zhou

et al. 2019

Obstetrics &Amp; Gynecology

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To evaluate the cost effectiveness of three different approaches to the care of neonates born at 22 weeks of gestation: universal resuscitation, selective resuscitation, or no resuscitation. METHODS:We constructed a decision-analytic model using TreeAge to compare the outcomes of death and survival with and without neurodevelopmental impairment in a theoretical cohort of 5,176 neonates (an estimate of the annual number of deliveries that occur in the 22nd week of gestation in the United States). We took a societal perspective using a lifetime horizon, and all costs were expressed in 2017 U.S. dollars. Effectiveness was based on combined maternal and neonatal quality-adjusted life years (QALYs). The incremental costeffectiveness ratio was determined (cost/QALY) for each additional survivor. The willingness to pay threshold was set at $100,000/QALY. All model inputs were derived from the literature. Deterministic and probabilistic sensitivity analyses were performed to interrogate model assumptions.RESULTS: Universal resuscitation would result in 373 survivors, 123 of whom would have severe disability. Selective resuscitation would produce 78 survivors with 26 affected by severe impairments. No resuscitation

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Improved Outcome of Infants Born at less than 24 Weeks of Gestation in Japan

Cited by 3 publications

References 9 publications

Survival, Short-Term, and Long-Term Morbidities of Neonates with Birth Weight < 500 g

Survival, Short-Term, and Long-Term Morbidities of Neonates with Birth Weight < 500 g

The child with medical complexity

Cost Effectiveness of Neonatal Resuscitation at 22 Weeks of Gestation

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