Resuscitation, survival and morbidity of extremely preterm infants in California 2011–2019

Higgins, Brennan V.; Baer, Rebecca J.; Steurer, Martina A.; Karvonen, Kayla L.; Oltman, Scott P.; Jelliffe-Pawlowski, Laura L.; Rogers, Elizabeth E.

doi:10.1038/s41372-023-01774-6

Cited by 7 publications

(1 citation statement)

References 35 publications

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“…In the last reporting period, 87.2% of EP infants treated in our NICU were inborn, 61.1% received prenatal care, and 49.7% were delivered via C-section. Delayed umbilical cord clamping was documented only for 15.4% of EP infants, less than reported in other studies [5], although this procedure brings many benefits [28]. It is recommended to perform DCC in preterm infants who do not require extensive resuscitation.…”

Section: Discussionmentioning

confidence: 85%

Updated Clinical Practice Guidelines in Resuscitation and the Management of Respiratory Distress Syndrome in Extremely Preterm Infants during Two Epochs in Romania: Impact on Outcomes

Cucerea,

Simon,

Anciuc-Crauciuc

et al. 2024

JCM

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Background: Adequate perinatal management is essential in caring for extremely preterm (EP) infants. We aimed to evaluate and compare the impact of different protocols on short-term outcomes. Methods: A retrospective study was conducted on EP infants in a Romanian perinatal tertiary center during 2008–2012 and 2018–2022. Results: Data on 270 EP infants (121 in period I, 149 in period II) were analyzed collectively and stratified into two subgroups by gestational age. Initial FiO2 administration (100% vs. 40%% p < 0.001), lung recruitment at birth (19.0% vs. 55.7% p < 0.001), early rescue surfactant administration (34.7% vs. 65.8%; p < 0.001), and the mechanical ventilation rate (98.3% vs. 58.4%; p < 0.001) were significantly improved during period II. Survival rates of EP infants significantly improved from 41.3% to 72.5%, particularly in the 26–28 weeks subgroup (63.8% to 83%). Compared to period I, the overall frequency of severe IVH decreased in period II from 30.6% to 14.1%; also, BPD rates were lower (36.6% vs. 23.4%; p = 0.045) in the 26–28 weeks subgroup. Despite improvements, there were no significant differences in the frequencies of NEC, sepsis, PVL, ROP, or PDA. Conclusions: Implementing evidence-based clinical guidelines can improve short-term outcomes.

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Section: Discussionmentioning

confidence: 85%

Updated Clinical Practice Guidelines in Resuscitation and the Management of Respiratory Distress Syndrome in Extremely Preterm Infants during Two Epochs in Romania: Impact on Outcomes

Cucerea,

Simon,

Anciuc-Crauciuc

et al. 2024

JCM

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Variation in NICU utilization: a narrative review and path forward

Paul,

Pearlman

2024

J Perinatol

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In-utero transfer, survival-focused care and survival to 28-days at 22-24 weeks’ gestation pre- and post- implementation of an extreme prematurity management guideline in Victoria, Australia

Gordon,

Shub,

Stewart

et al. 2024

bmjpo

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BackgroundCare for infants born at 22–24 weeks’ gestation varies globally, with an increasing willingness to provide survival-focused (‘active’) care for infants born at 22 weeks’ gestation in recent years. This study aims to report changes in care for infants born at 22–24 weeks before and after the introduction of a statewide guideline for extreme prematurity (EP).MethodsA retrospective cohort study was conducted, including all live births at 22–24 weeks in tertiary perinatal centres from 1 January 2015 to 31 December 2022 in Victoria, Australia. Medical records were reviewed to obtain antenatal history and perinatal outcomes. Data on in utero referral and transfer to tertiary perinatal centres were sourced from the statewide perinatal emergency retrieval service (Paediatric Infant Perinatal Emergency Retrieval, PIPER) database. Changes in PIPER referrals and transfers, survival-focused care and survival at 28 days preguideline and postguideline were assessed using logistic regression.ResultsFollowing the guideline, at 22 weeks’ gestation, there was an increase in referrals to PIPER and a 3.31 (95% CI 1.84 to 5.95) higher likelihood of in utero transfer to tertiary centres.Following the guideline, infants had a 6.67 (95% CI 1.40 to 31.72) higher likelihood of receiving survival-focused care at 22 weeks, and a 5.57 (95% CI 1.22 to 25.44) higher likelihood at 23 weeks. All 24-week live births received survival-focused care at birth. The 28-day survival for infants who received survival-focused care was unchanged preguideline and postguideline.ConclusionFollowing the publication of the EP guideline in Victoria, in utero referrals and transfers at 22 weeks’ gestation have increased, as has survival-focused management of inborn live births at 22–24 weeks.

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Resuscitation, survival and morbidity of extremely preterm infants in California 2011–2019

Cited by 7 publications

References 35 publications

Updated Clinical Practice Guidelines in Resuscitation and the Management of Respiratory Distress Syndrome in Extremely Preterm Infants during Two Epochs in Romania: Impact on Outcomes

Updated Clinical Practice Guidelines in Resuscitation and the Management of Respiratory Distress Syndrome in Extremely Preterm Infants during Two Epochs in Romania: Impact on Outcomes

Variation in NICU utilization: a narrative review and path forward

In-utero transfer, survival-focused care and survival to 28-days at 22-24 weeks’ gestation pre- and post- implementation of an extreme prematurity management guideline in Victoria, Australia

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