The limit of viability--neonatal outcome of infants born at 22 to 25 weeks' gestation.
ABSTRACT With improved survival of preterm infants, questions have been raised about the limit of viability. To provide better information and counseling for parents of infants about to be delivered after 22 to 25 weeks' gestation, we evaluated the mortality and neonatal morbidity of preterm infants born at these gestational ages.
We studied retrospectively all 142 infants born at 22 to 25 weeks' gestation (as judged by best obstetrical estimate) from May 1988 through September 1991 in a single hospital. Mortality in the first six months, including stillbirths, and neonatal morbidity (i.e., the presence of intracranial pathologic conditions, chronic lung disease, and retinopathy of prematurity) were analyzed.
Fifty-six infants (39 percent) survived for six months. Survival improved with increasing gestational age; none of 29 infants born at 22 weeks' gestation survived, as compared with 6 of 40 (15 percent) born at 23 weeks, 19 of 34 (56 percent) born at 24 weeks, and 31 of 39 (79 percent) born at 25 weeks. There were seven stillbirths at 22 weeks' gestation and four stillbirths at 23 weeks. The more immature the infant, the higher the incidence of neonatal complications as determined by the number of days of mechanical ventilation, the length of the hospital stay, and the presence of retinopathy of prematurity, periventricular or intraventricular hemorrhage, or periventricular leukomalacia. Only 2 percent of infants born at 23 weeks' gestation survived without severe abnormalities on cranial ultrasonography, as compared with 21 percent of those born at 24 weeks and 69 percent of those born at 25 weeks.
We believe that aggressive resuscitation of infants born at 25 weeks' gestation is indicated, but not of those born at 22 weeks. Whether the occasional child who is born at 23 or 24 weeks' gestation and does well justifies the considerable mortality and morbidity of the majority is a question that should be discussed by parents, health care providers, and society.
Article: The Problem of Low Birth Weight[Show abstract] [Hide abstract]
ABSTRACT: Low birth weight is a major public health problem in the United States, contributing substantially both to infant mortality and to childhood handicap. The principal determinant of low birth weight in the United States is preterm delivery, a phenomenon of largely unknown etiology. Preterm delivery is more common in the United States than in many other industrialized nations, and is the factor most responsible for the relatively high infant mortality rate in the United States. Within the United States, Asian populations experience the lowest preterm delivery rates, while Hispanic and Native American populations experience slightly higher preterm delivery rates than the white population. African Americans, however, have much higher rates of preterm delivery than any of the other major ethnic groups. Poverty is strongly and consistently associated with low birth weight, but the precise social and environmental conditions that produce preterm delivery have not been elucidated. Although it is popular to link illicit drug use to low birth weight, a high low birth weight rate was characteristic of the United States for decades before the cocaine epidemic of the 1980s. Neither the low birth weight rate nor the preterm delivery rate has improved in the United States in the past quarter century. Most efforts to prevent prematurity or low birth weight, when carefully evaluated, have not proven effective. A major goal of biomedical research ought to be better understanding of the causes of this important public health problem.The Future of Children 03/1995; 5(1):19. DOI:10.2307/1602505 · 1.98 Impact Factor
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ABSTRACT: Introduction: In Nigeria, the age of fetal viability is defined as fetus that have achieved at least 28 weeks of gestation in utero, while World Health Organization (WHO) has reduced this age to 24 weeks gestation. By implication, delivery prior to 28 weeks gestation is regarded as abortion. There is therefore an urgent need to review this age old criteria for standard of care in Nigeria. Case presentation: A 27-year old G2P0 + 1 Nigerian Igbo woman, with no living child. She had previous pregnancy loss due to cervical incompetence and had cervical cerclage inserted at 14 weeks gestation in the index pregnancy. The pregnancy subsequently remained uneventful until at 26 weeks 5 days gestation when she had pre-viable pre-labour rupture of membranes with breech presentation. Conservative approach was adopted following counseling until thirty six hours later, when she had cord prolapse with live pre-viable fetus (inevitable abortion). The dilemma was to manage the woman as cord prolapse with live fetus and attempt to salvage the fetus or to manage as inevitable abortion and allow for spontaneous expulsion of the fetus. She subsequently had emergency hysterotomy with a delivery of live male baby with good APGAR score. The birth weight was 1.03 kg. He was discharged at the 10th week of life at a weight of 1.9 kg with no developmental deficit. Conclusion: We recommend the re-definition of the age of fetal viability in Nigeria considering the improvement in facilities to agree with WHO recommendation of 24 weeks gestation. Keywords Re-definition; Age of fetal viability; Inevitable abortion; 28 weeks gestation; 24 weeks gestation; World Health Organization
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ABSTRACT: Drug studies in developing pediatric patients, especially newborns, create many ethical challenges that can be analyzed in terms of respect for persons, justice, and beneficence/maleficence as outlined in the Belmont Report. This report describes some of the ethical challenges in conducting drug studies in pediatric patients that must be considered when planning studies and offers some solutions to meet those challenges. Methods of optimal study design should be utilized to limit the number of patients and the number of blood samples. Parental permission should be obtained with equipoise, although the parents of a sick newborn may feel an internal pressure for their child to participate in a study of a new and potentially superior therapy. If appropriate to the study, consent before labor and delivery when parents are less stressed is optimal. It may be difficult or impossible to know all the risks and benefits accompanying studies in newborns due to the limited number of randomized controlled studies in this population. Many more carefully designed, randomized controlled studies of drugs are needed to address the therapeutic needs of the developing pediatric population. For sick newborns cared for in the neonatal intensive care unit (NICU), those studies should be better focused on the drugs used daily in their cares.Paediatric Drugs 10/2014; 17(1). DOI:10.1007/s40272-014-0099-8 · 1.72 Impact Factor