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Outcomes following periviable birth

Cody Arnold1, Jon E Tyson2

  • 1Department of Pediatrics, University of Texas Health Science Center at Houston Medical School, 6431 Fannin, St, MSB 3.242, Houston, TX 77030.

Seminars in Perinatology
|January 29, 2014
PubMed

Insights

Extending intensive care to more premature newborns increases survival but also morbidity. Perinatal center delivery and care decisions significantly impact outcomes for periviable infants.

Area of Science:

  • Neonatalogy
  • Perinatal Medicine
  • Medical Ethics

Background:

  • Intensive care is increasingly extended to lower gestational age newborns.
  • This trend may increase the number of survivors with morbidity.
  • Gestational age is a primary factor in decisions about intensive care.

Purpose of the Study:

  • To review background concepts in periviable birth.
  • To analyze recent cohort reports on periviable birth outcomes.
  • To discuss prognosis research from the National Institutes of Health Neonatal Research Network.

Main Methods:

  • Review of background literature on neonatal intensive care.
  • Analysis of geographically defined cohort studies on periviable births.
  • Examination of prognosis research from a major neonatal network.

Main Results:

  • Extending intensive care to lower gestational ages increases both the proportion and absolute number of survivors with morbidity.
  • The proportion of periviable infants delivered at perinatal centers influences outcomes.
  • Practices regarding foregoing or withdrawing intensive care are key determinants of outcomes but harder to quantify.

Conclusions:

  • Outcomes for periviable infants depend on delivery location and care withdrawal decisions.
  • Gestational age alone is insufficient for making intensive care decisions.
  • Multiple factors should inform decisions to better assess benefits/burdens and counsel parents.

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