2020
DOI: 10.1136/archdischild-2019-318402
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Perinatal management of extreme preterm birth before 27 weeks of gestation: a framework for practice

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Cited by 156 publications
(137 citation statements)
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References 37 publications
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“…Lower mortality rates may be associated with greater obstetric expertise at these units, such as appropriate steroid administration and skilled caesarean delivery of the preterm breech. The finding that more women received appropriate antenatal corticosteroid administration in higher-level units supports this assumption 1 . The contribution of pre-transfer deaths was recognised by Boland et al , who suggested that the perceived poor prognosis at earlier gestations was likely to have prohibited decisions to transfer in referring units (which in fact had a 69% chance of survival if admitted to NICU); in effect, these babies were not given the same chance to survive 10 .…”
Section: Why Do We Need In Utero Transfer?mentioning
confidence: 74%
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“…Lower mortality rates may be associated with greater obstetric expertise at these units, such as appropriate steroid administration and skilled caesarean delivery of the preterm breech. The finding that more women received appropriate antenatal corticosteroid administration in higher-level units supports this assumption 1 . The contribution of pre-transfer deaths was recognised by Boland et al , who suggested that the perceived poor prognosis at earlier gestations was likely to have prohibited decisions to transfer in referring units (which in fact had a 69% chance of survival if admitted to NICU); in effect, these babies were not given the same chance to survive 10 .…”
Section: Why Do We Need In Utero Transfer?mentioning
confidence: 74%
“…An excess of deaths prior to transfer from level 1 or 2 settings is missed by analysing NICU data alone, creating a bias against in utero transfer. For example, the EPICURE 2 cohort’s antenatal foetal deaths (32% mortality in level 1 units versus 15% in level 3) contribute significantly to the UK perinatal mortality 1 . Mothers of extreme preterm infants born in the appropriate setting benefit from tertiary obstetric input and expert delivery room resuscitation.…”
Section: Why Do We Need In Utero Transfer?mentioning
confidence: 99%
See 1 more Smart Citation
“…However, in the updated 2019 framework, published in this issue, the working group reached the opposite conclusion: ‘In the absence of sufficient evidence to justify a different approach in extremely preterm babies, if advanced resuscitation is considered appropriate, the Working Group recommends applying newborn resuscitation algorithms as used in more mature babies” 2…”
mentioning
confidence: 99%
“…Babies requiring surgery will be transferred to Royal London Hospital (pediatric surgery), Guy's and St Thomas' Hospital (cardiac) and Great Ormond Street Hospital (cardiac & all other sub-specialties). The unit practice was to resuscitate babies from ≥23 weeks of gestation at birth as per national guideline (since October 2019, the unit resuscitates babies born at 22 weeks' gestation after careful risk assessment) [8]. Almost all mothers receive full antenatal care and steroids uptake rate is more than 90%.…”
Section: Methodsmentioning
confidence: 99%