Active care of infants born between 22 and 26 weeks of gestation does not follow consensus expert recommendations

Sinclair, Ruth, Bajuk, Barbara, Guaran, Robert, Challis, Daniel, Sheils, Joanne, Abdel-Latif, Mohamed E., Hilder, Lisa, Wright, Ian M., and Oei, Ju Lee (2019) Active care of infants born between 22 and 26 weeks of gestation does not follow consensus expert recommendations. Acta Paediatrica, 108 (7). pp. 1222-1229.

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Aim: To determine the relationship between clinical practice and publication of an Australian consensus statement for management of extremely preterm infants in 2006.

Methods: A population-based study using linked data from New South Wales, Australia for births between 22 + 0 and 26 + 6 weeks of gestation between 2000 and 2011.

Results: There were 4746 births of whom 2870 were liveborn and 1876 were stillborn. Of the live births, 2041 (71%) were resuscitated, 1914 (67%) were admitted into a neonatal intensive care unit (NICU) and 1310 (46%) survived to hospital discharge. Thirty-nine (2%) stillbirths were resuscitated but none survived. No 22-week infant survived to hospital discharge. Fewer 23-week gestation infants were resuscitated between 2004 (52%) and 2005 (20%) but resuscitation rates increased by 2008 (44%). There was no difference at other gestations. Adjusted odds ratio (OR) for resuscitation was increased by birthweight (OR: 1.01), tertiary hospital birth (OR: 3.4) and Caesarean delivery (OR: 11.3) and decreased by rural residence (OR: 0.4) and male gender (OR: 0.7).

Conclusion: Expert recommendations may be shaped by clinical practice rather than the converse, especially for 23-week gestation infants. Recommendations should be revised regularly to include clinical practice changes.

Item ID: 62771
Item Type: Article (Research - C1)
ISSN: 1651-2227
Keywords: Consensus statement, Delivery room resuscitation, Extremely preterm, Outcomes
Copyright Information: ©2019 Foundation Acta Pædiatrica.
Date Deposited: 11 May 2020 23:47
FoR Codes: 32 BIOMEDICAL AND CLINICAL SCIENCES > 3213 Paediatrics > 321303 Neonatology @ 100%
SEO Codes: 92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920501 Child Health @ 100%
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