Intensive care for extreme prematurity--moving beyond gestational age.

Center for Clinical Research and Evidence-Based Medicine, University of Texas Medical School at Houston, Houston, TX 77030, USA.
New England Journal of Medicine (Impact Factor: 54.42). 05/2008; 358(16):1672-81. DOI: 10.1056/NEJMoa073059
Source: PubMed

ABSTRACT Decisions regarding whether to administer intensive care to extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients.
We prospectively studied a cohort of 4446 infants born at 22 to 25 weeks' gestation (determined on the basis of the best obstetrical estimate) in the Neonatal Research Network of the National Institute of Child Health and Human Development to relate risk factors assessable at or before birth to the likelihood of survival, survival without profound neurodevelopmental impairment, and survival without neurodevelopmental impairment at a corrected age of 18 to 22 months.
Among study infants, 3702 (83%) received intensive care in the form of mechanical ventilation. Among the 4192 study infants (94%) for whom outcomes were determined at 18 to 22 months, 49% died, 61% died or had profound impairment, and 73% died or had impairment. In multivariable analyses of infants who received intensive care, exposure to antenatal corticosteroids, female sex, singleton birth, and higher birth weight (per each 100-g increment) were each associated with reductions in the risk of death and the risk of death or profound or any neurodevelopmental impairment; these reductions were similar to those associated with a 1-week increase in gestational age. At the same estimated likelihood of a favorable outcome, girls were less likely than boys to receive intensive care. The outcomes for infants who underwent ventilation were better predicted with the use of the above factors than with use of gestational age alone.
The likelihood of a favorable outcome with intensive care can be better estimated by consideration of four factors in addition to gestational age: sex, exposure or nonexposure to antenatal corticosteroids, whether single or multiple birth, and birth weight. ( numbers, NCT00063063 [] and NCT00009633 [].).

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    ABSTRACT: The concept that adequate nutritional status and normal growth are important is well-accepted. How to assess the adequacy of nutrition and how to define appropriate growth remains an area of active debate. Our goal is to review how growth is assessed at birth and during the hospital stay of prematurely born infants, and to offer a standardized approach.
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    ABSTRACT: 143 OriginalArticle T he major cause of perinatal and neonatal morbidity and mortality is still from preterm labor and deli-very. Preterm birth before 24 weeks of gesta-tion may be defined as abortion in some centers. Preterm babies with lowest gestational age and birth weight were correlated with the highest risk of fetal death. 1,2 However, survival rates for preterm birth in tertiary cares are high because of the highest level of neonatal intensive care which provides mechanical ventilation and well-trained neonatologists. 3 Siriraj Hospital is the tertiary center where the com-plicated cases are referred for intensive care, therefore the preterm birth rate was high. The trend of preterm delivery in Siriraj Hospital has changed for 9 years. The situation of financial problems, social policy and hospital contract insurance were the major issues for the patients to make a decision of the place for delivery. The advanced technique of assisted reproduction, a high prevalence of complicated pregnancies and other related causes have resulted in the ABSTRACT Objective: To determine the preterm birth rate, neonatal birth weight and causes of early neonatal death at Siriraj Hospital over a 9-year period (2002-2010). Methods: The medical records of preterm birth, threatened preterm labor and neonatal birth weight at Siriraj Hospital from 2002 to 2010 were retrospectively collected and reviewed. The data was analyzed by SPSS version 13. Results: During a 9-year period, 2002-2010, the birth rate decreased steadily from 2002 to 2006, but increased suddenly from 2007 to 2010. The rate of preterm birth was increased steadily from 2004 to 2010 (9.44%-13.70%). The rate of threatened preterm labor was constantly between 6.0 and 8.9%. Among preterm births, low birth weight infants were mostly found except in the year 2003. Early neonatal death was mostly caused from fetal abnormality. The trend of neonatal death from prematurity had continuously declined and there was no early neonatal death from 2008 to 2010. Conclusion: Regarding this 9-year review, the preterm birth rate increased from 2007 to 2010 while premature babies mostly survived.
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    Tijdschrift voor geneeskunde. 01/2014; 70(20).

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