Perinatal care for the extremely preterm infant

Haruo Usuda; Sean Carter; Tsukasa Takahashi; John P Newnham; Erin L Fee; Alan H Jobe; Matthew W Kemp

doi:10.1016/j.siny.2022.101334

Perinatal care for the extremely preterm infant

Semin Fetal Neonatal Med. 2022 Apr;27(2):101334. doi: 10.1016/j.siny.2022.101334. Epub 2022 Apr 15.

Authors

Haruo Usuda¹, Sean Carter², Tsukasa Takahashi¹, John P Newnham³, Erin L Fee³, Alan H Jobe⁴, Matthew W Kemp⁵

Affiliations

¹ Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia; Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, 980-8574, Japan.
² Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228, Singapore.
³ Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia.
⁴ Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia; Perinatal Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Centre, University of Cincinnati, Cincinnati, OH, 45229, USA.
⁵ Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, 119228, Singapore; School of Veterinary and Life Sciences, Murdoch University, Perth, Western Australia, 6150, Australia; Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, 980-8574, Japan. Electronic address: kemma@nus.edu.sg.

PMID: 35577715
DOI: 10.1016/j.siny.2022.101334

Abstract

Being born preterm (prior to 37 weeks of completed gestation) is a leading cause of childhood death up to five years of age, and is responsible for the demise of around one million preterm infants each year. Rates of prematurity, which range from approximately 5 to 18% of births, are increasing in most countries. Babies born extremely preterm (less than 28 weeks' gestation) and in particular, in the periviable (20^0/7-25^6/7 weeks) period, are at the highest risk of death, or the development of long-term disabilities. The perinatal care of extremely preterm infants and their mothers raises a number of clinical, technical, and ethical challenges. Focusing on 'micropremmies', or those born in the periviable period, this paper provides an update regarding the aetiology and impacts of periviable preterm birth, advances in the antenatal, intrapartum, and acute post-natal management of these infants, and a review of counselling/support approaches for engaging with the infant's family. It concludes with an overview of emerging technology that may assist in improving outcomes for this at-risk population.

Keywords: Extremely preterm; Neonatology; Obstetrics; Periviable; Preterm birth; Very low birth weight.

Publication types

Review

MeSH terms

Child
Female
Gestational Age
Humans
Infant
Infant, Extremely Premature
Infant, Newborn
Infant, Premature, Diseases* / epidemiology
Perinatal Care
Pregnancy
Premature Birth*