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

Ruth Sinclair; Barbara Bajuk; Robert Guaran; Daniel Challis; Joanne Sheils; Mohamed E Abdel-Latif; Lisa Hilder; Ian M Wright; Ju Lee Oei

doi:10.1111/apa.14714

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

Acta Paediatr. 2019 Jul;108(7):1222-1229. doi: 10.1111/apa.14714. Epub 2019 Feb 14.

Authors

Ruth Sinclair¹, Barbara Bajuk², Robert Guaran^{2

3

4}, Daniel Challis^{1

2

4}, Joanne Sheils², Mohamed E Abdel-Latif^{5

6}, Lisa Hilder⁷, Ian M Wright^{8

9}, Ju Lee Oei^{1

4}

Affiliations

¹ Department of Newborn Care, The Royal Hospital for Women, Randwick, NSW, Australia.
² Perinatal Services Network, Sydney Children's Hospitals Network, Randwick, NSW, Australia.
³ Department of Neonatology, Liverpool Hospital, Liverpool, NSW, Australia.
⁴ School of Women's and Children's Health, University of New South Wales, Randwick, NSW, Australia.
⁵ Department of Neonatology, The Canberra Hospital, Garran, ACT, Australia.
⁶ Faculty of Medicine, The Australian National University, Deakin, ACT, Australia.
⁷ National Drug and Alcohol Research Centre, Randwick, NSW, Australia.
⁸ Illawarra Health and Medical Research Institute, Graduate School of Medicine, The University of Wollongong, Wollongong, NSW, Australia.
⁹ Department of Paediatrics, The Wollongong Hospital, Wollongong, NSW, Australia.

PMID: 30614556
DOI: 10.1111/apa.14714

Abstract

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.

Keywords: Consensus statement; Delivery room resuscitation; Extremely preterm; Outcomes.

MeSH terms

Gestational Age
Guideline Adherence
Humans
Infant, Extremely Premature*
Infant, Newborn
Intensive Care Units, Neonatal
Perinatal Mortality*
Practice Guidelines as Topic
Resuscitation / statistics & numerical data*
Resuscitation / trends
Stillbirth