July 3, 2012
Infants born extremely prematurely, at 22 to 24 weeks gestation, have a very high risk of death as they are the youngest infants who have any chance of survival. Practitioners generally agree that it is best to use an aggressive intensive care approach with infants born between 25 and 27 weeks gestation, but treatment for the youngest infants can vary significantly among health care centers. Differences in care practices are linked with changes in outcomes and patient complications.
A new study sought to find out whether an aggressive treatment approach for babies born at 22 to 24 weeks was also associated with better outcomes for babies born at 25 to 27 weeks. The results were published in the June issue of Pediatrics. Brian Smith, MD, MPH, MHS, Associate Professor of Pediatrics in the Division of Neonatology and Chief of the Division of Quantitative Sciences, Pediatrics, was the lead author.
Aggressive treatment included giving at-risk mothers corticosteroids prior to delivery to speed up development of the baby’s lungs, opting for caesarean delivery, and resuscitating the infant after birth. The observational study enrolled more than 3,600 infants born between 22 and 24 weeks and more than 5,200 infants born between 25 and 27 weeks at 20 hospitals.
There was a wide range of obstetrical and neonatal care practices across hospitals. The percentage of centers using pre-delivery corticosteroids for babies born at 22 to 24 weeks ranged from 28 percent to 100 percent, and the percentage of centers using resuscitation for the same age group ranged from 30 percent to 100 percent.
Hospitals with higher rates of corticosteroid use for mothers who delivered between 22 and 24 weeks had lower rates of mortality, late-onset sepsis, necrotizing enterocolitis, or neurodevelopment impairment in the infants delivered between 25 and 27 weeks. Using an aggressive approach in the infants born between 22 and 24 weeks was also associated with lower mortality rates for the younger group.
Guidelines currently recommend giving corticosteroids to women at high risk of delivering between 24 and 34 weeks, and further study is needed to determine risks and benefits for earlier use.
Overall, the infants born between 25 and 27 weeks were more likely than the infants born between 22 and 23 weeks to have been delivered via caesarean section and resuscitated at birth and to have received pre-birth corticosteroids. The 24-week-old infants received interventions nearly as often as the older infant group.
Researchers hope that identifying hospitals with higher survival rates and fewer significant complications in the youngest gestational age infants will help identify the practices most likely to increase the number of infants who survive without developing serious complications. It is hoped that those practices could be applied at other hospitals to improve outcomes in the neonatal population.