Delivery room management of extremely preterm infants: the EPIPAGE-2 study

Area of Science:

• Neonatalogy
• Perinatal Medicine
• Bioethics

Background:

• Delivery room management of extremely preterm infants is complex.
• Decisions regarding intensive care significantly impact survival rates.
• Variability in care practices exists across different healthcare settings.

Purpose of the Study:

• To analyze the delivery room management of infants born between 22 and 26 weeks of gestational age.
• To identify factors influencing the withholding or withdrawal of intensive care.
• To examine the role of gestational age in these critical decisions.

Main Methods:

• Population-based cohort study.
• Inclusion of 2145 births between 22 and 26 completed weeks gestational age from the EPIPAGE-2 study.
• Primary outcome: withholding or withdrawal of intensive care in the delivery room.

Main Results:

• Over 90% of infants born at 22-23 weeks had intensive care withheld or withdrawn.
• At 24 weeks, 38% of infants had care withheld/withdrawn; at 25 weeks, 8%; at 26 weeks, 3%.
• Factors associated with withholding/withdrawal included low birth weight (<600g), emergency delivery, and singleton pregnancy.

Conclusions:

• Gestational age is the primary factor influencing intensive care decisions for extremely preterm infants in France.
• This practice has direct implications for infant survival.
• Ethical considerations of basing life-or-death decisions solely on gestational age before 25 weeks warrant further investigation.