Úrsula Guillén1, Elliott M Weiss2, David Munson2, Pierre Maton3, Ann Jefferies4, Mikael Norman5, Gunnar Naulaers6, Joana Mendes7, Lincoln Justo da Silva8, Petr Zoban9, Thor W R Hansen10, Mikko Hallman11, Maria Delivoria-Papadopoulos12, Shigeharu Hosono13, Susan G Albersheim14, Constance Williams15, Elaine Boyle16, Kei Lui17, Brian Darlow18, Haresh Kirpalani2. 1. Division of Neonatology, Christiana Care Health System, Newark, Delaware; ursula.guillen@gmail.com. 2. Division of Neonatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; 3. CHC St Vincent, Rocourt, Belgium; 4. Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada; 5. Department of Neonatal Medicine, Karolinska Hospital, Stockholm, Sweden; 6. Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium; 7. Sao Francisco Xavier Hospital, Lisbon, Portugal; 8. Department of Pediatrics, Lisbon Medical School, Lisbon, Portugal; 9. Department of Neonatology, Charles University, Prague, Czech Republic; 10. Women & Children's Division, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway; 11. Department of Pediatrics, Oulu University Hospital and University of Oulu, Oulu, Finland; 12. Division of Neonatology, St Christopher's Hospital for Children, Philadelphia, Pennsylvania; 13. Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan; 14. Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada; 15. Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada; 16. Department of Pediatrics, University of Leicester, Leicester, United Kingdom; 17. Department of Newborn Care, University of New South Wales, Sydney, Australia; and. 18. Department of Pediatrics, University of Otago, Christchurch, New Zealand.
Abstract
BACKGROUND AND OBJECTIVES: Available data on survival rates and outcomes of extremely low gestational age (GA) infants (22-25 weeks' gestation) display wide variation by country. Whether similar variation is found in statements by national professional bodies is unknown. The objectives were to perform a systematic review of management from scientific and professional organizations for delivery room care of extremely low GA infants. METHODS: We searched Embase, PubMed, and Google Scholar for management guidelines on perinatal care. Countries were included if rated by the United Nations Development Programme's Human Development Index as "very highly developed." The primary outcome was rating of recommendations from "comfort care" to "active care." Secondary outcomes were specifying country-specific survival and considering potential for 3 biases: limitations of GA assessment; bias from different definitions of stillbirths and live births; and bias from the use of different denominators to calculate survival. RESULTS: Of 47 highly developed countries, 34 guidelines from 23 countries and 4 international groups were identified. Of these, 3 did not state management recommendations. Of the remaining 31 guidelines, 21 (68%) supported comfort care at 22 weeks' gestation, and 20 (65%) supported active care at 25 weeks' gestation. Between 23 and 24 weeks' gestation, much greater variation was seen. Seventeen guidelines cited national survival rates. Few guidelines discussed potential biases: limitations in GA (n = 17); definition bias (n = 3); and denominator bias (n = 7). CONCLUSIONS: Although there is a wide variation in recommendations (especially between 23 and 24 weeks' GA), there is general agreement for comfort care at 22 weeks' GA and active care at 25 weeks' GA.
BACKGROUND AND OBJECTIVES: Available data on survival rates and outcomes of extremely low gestational age (GA) infants (22-25 weeks' gestation) display wide variation by country. Whether similar variation is found in statements by national professional bodies is unknown. The objectives were to perform a systematic review of management from scientific and professional organizations for delivery room care of extremely low GA infants. METHODS: We searched Embase, PubMed, and Google Scholar for management guidelines on perinatal care. Countries were included if rated by the United Nations Development Programme's Human Development Index as "very highly developed." The primary outcome was rating of recommendations from "comfort care" to "active care." Secondary outcomes were specifying country-specific survival and considering potential for 3 biases: limitations of GA assessment; bias from different definitions of stillbirths and live births; and bias from the use of different denominators to calculate survival. RESULTS: Of 47 highly developed countries, 34 guidelines from 23 countries and 4 international groups were identified. Of these, 3 did not state management recommendations. Of the remaining 31 guidelines, 21 (68%) supported comfort care at 22 weeks' gestation, and 20 (65%) supported active care at 25 weeks' gestation. Between 23 and 24 weeks' gestation, much greater variation was seen. Seventeen guidelines cited national survival rates. Few guidelines discussed potential biases: limitations in GA (n = 17); definition bias (n = 3); and denominator bias (n = 7). CONCLUSIONS: Although there is a wide variation in recommendations (especially between 23 and 24 weeks' GA), there is general agreement for comfort care at 22 weeks' GA and active care at 25 weeks' GA.
Authors: Matthew J Drago; Ursula Guillén; Maria Schiaratura; Jennifer Batza; Annette Zygmunt; Anja Mowes; David Munson; John M Lorenz; Christiana Farkouh-Karoleski; Haresh Kirpalani Journal: Matern Child Health J Date: 2018-07
Authors: R Geurtzen; J F M van den Heuvel; J J Huisman; E M Lutke Holzik; M N Bekker; M Hogeveen Journal: J Perinatol Date: 2021-07-20 Impact factor: 2.521