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Published on: November 20, 2015
[Perinatal care for extremely preterm infants. Considerations of the "risks in pregnancy" department]
P-H Jarreau1, L Allal2, F Autret3
1Département hospitalo-universitaire (DHU) « risques et grossesse », 53, avenue de l'Observatoire, 75014 Paris, France; Service de médecine et réanimation néonatales de Port-Royal, hôpital Cochin, hôpitaux universitaires Paris Centre, université Paris Descartes, AP-HP, 53, avenue de l'Observatoire, 75014 Paris, France.
Insights
Decisions for extremely premature infants require more than gestational age. Prognosis assessment should include additional factors and multidisciplinary input for better infant care.
Area of Science:
- Neonatal Medicine
- Perinatology
- Medical Ethics
Background:
- Current intensive care decisions for extremely premature infants often rely solely on gestational age.
- This narrow focus overlooks crucial prognostic factors impacting infant outcomes.
- A more comprehensive approach is needed for ethical and effective care planning.
Purpose of the Study:
- To review factors beyond gestational age influencing prognosis in extremely premature infants.
- To propose updated guidelines for decision-making regarding intensive care.
- To enhance the assessment of infant prognosis and parental counseling.
Main Methods:
- Review of existing literature on prognostic factors for extremely premature infants.
- Analysis of current practices in intensive care decision-making.
- Development of proposals by the Risks and Pregnancy department.
Main Results:
- Gestational age alone is insufficient for accurate prognosis in extremely premature infants.
- Other factors, including prenatal predicted fetal weight, significantly influence outcomes.
- Multidisciplinary consultation and parental discussion are vital for informed decisions.
Conclusions:
- Prognosis assessment for extremely premature infants must integrate multiple factors beyond gestational age.
- Recommendations include limiting emergency decisions and separating prenatal steroid therapy from intensive care decisions.
- Implementing multidisciplinary consultations will improve the evaluation and discussion of care options with parents.
Abstract:
Decisions regarding whether to initiate or forgo intensive care for extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients and must be taken into account. After a short review of these factors, we present the thoughts and proposals of the Risks and Pregnancy department. The proposals are to limit emergency decisions, to better take into account other factors than gestational age and prenatal predicted fetal weight in assessing the prognosis, to introduce multidisciplinary consultation in the evaluation and proposals that will be discussed with the parents, and to separate prenatal steroid therapy from decision-making regarding whether or not to administer intensive care.
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