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Consensus statement on perinatal care.

¹Neonatology, King Edward Memorial Hospital, Subiaco and State Child Development Centre, West Perth, Western Australia, Australia. noel.french@health.wa.gov.au

Journal of Paediatrics and Child Health

|May 31, 2007

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Practices for preterm infants at the margins of viability, especially at 23 weeks gestation, vary across Australian regions. New South Wales/Australian Capital Territory discourages intervention, impacting survival rates for extremely preterm infants.

Area of Science:

Perinatal medicine
Neonatal intensive care
Public health policy

Background:

Consensus statements provide a framework for managing infants born at the margins of viability.
Observed differences in clinical practice exist between New South Wales/Australian Capital Territory (NSW/ACT) and other Australian regions, particularly concerning 23-week gestation infants.
Lower regional survival rates at 23 weeks in NSW/ACT suggest a more conservative approach to active intervention.

Purpose of the Study:

To examine regional variations in the management of infants born at the margins of viability.
To evaluate the impact of differing intervention thresholds on survival and disability rates.
To advocate for a consistent approach to intensive care initiation for eligible infants based on parental wishes.

Main Methods:

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Comparative analysis of regional survival data for infants born at marginal gestations (23-25 weeks).
Review of current clinical practices and consensus guidelines regarding active intervention.
Assessment of outcomes, including severe disability, for surviving infants.

Main Results:

NSW/ACT demonstrates lower survival rates at 23 weeks gestation compared to other Australian regions.
This disparity is attributed to a policy of discouraging active intervention at this gestation in NSW/ACT.
Infants surviving marginal gestations, including 25 weeks, have a majority of favorable outcomes with minimal severe disability.

Conclusions:

There is a need to reconsider the threshold for active intervention at marginal gestations, particularly 23 weeks.
Initiation of intensive care for infants of marginal gestations should be supported when parents provide informed consent.
Standardizing care and promoting active intervention, where appropriate, can improve survival and reduce disability in extremely preterm infants.