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Prediction of outcome in 164 infants born after 24 to 28 weeks gestation
1Department of Neonatology, Rigshospitalet, Copenhagen, Denmark.
Insights
Predicting serious handicap in extremely preterm infants remains challenging. This study highlights the ethical dilemma faced by healthcare providers, emphasizing trust between parents and staff.
Area of Science:
- Neonatal Medicine
- Pediatric Neurology
- Medical Ethics
Background:
- Infants born extremely preterm (24-28 weeks) face significant risks.
- Neurological complications and major handicaps are common in this vulnerable population.
Purpose of the Study:
- To assess the long-term neurodevelopmental outcomes of extremely preterm infants.
- To evaluate the ability to predict serious handicap in this cohort.
- To address the ethical considerations in managing extremely preterm infants.
Main Methods:
- Retrospective analysis of 164 infants born between 24 and 28 completed weeks gestation (1984-1987).
- Follow-up assessment for major handicaps including cerebral palsy, low IQ (<50), and blindness.
- Review of cases where respirator treatment was withdrawn due to severe intracranial bleeding and periventricular leucomalacia.
Main Results:
- 18% of surviving infants (102 total) experienced a major handicap.
- 6% had multiple major handicaps.
- Respirator treatment was withdrawn in 6 infants due to severe neurological injury.
Conclusions:
- Reliable prediction of serious handicap in extremely preterm infants remains difficult.
- An ethical dilemma exists regarding treatment withdrawal and care decisions.
- A strong trust relationship between parents and healthcare staff is crucial for navigating these challenges.
Abstract:
Between 1984 and 1987 164 infants born after 24 to 28 completed weeks were admitted to our unit. In 6 children respirator treatment was withdrawn between days 6 and 57 mainly on the basis of severe intracranial bleeding and periventricular leucomalacia. Among 102 (62%) surviving infants, 18 (18%) had a major handicap (cerebral palsy, IQ less than 50, blindness) at follow-up, in 6 of the 18 (6%) there was a combination of several major handicaps. We conclude that we can still not reliably predict serious handicap and we are therefore faced with a serious ethical dilemma which we think can best be approached in a trust-relationship between parents and staff.