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Deliveries at extreme prematurity: outcomes, approaches, institutional variation, and uncertainty

Bonnie H Arzuaga1, Christy L Cummings

  • 1Division of Newborn Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Current Opinion in Pediatrics
|January 5, 2019
PubMed

Insights

Medical decision-making for extremely premature births is complex. Emerging guidelines and shared decision-making can improve care, but challenges like practice variation and data limitations persist.

Area of Science:

  • Neonatalogy
  • Perinatal Medicine
  • Medical Ethics

Background:

  • Medical decision-making for extremely premature births presents significant challenges for families and healthcare providers.
  • Concerns exist regarding practice variations, selection bias, and limitations in outcomes data for this vulnerable population.

Purpose of the Study:

  • To review recent literature on deliveries at extreme prematurity.
  • Focus on outcomes, clinical approaches, and institutional variations in care.

Main Methods:

  • Literature review of recent studies on extreme prematurity.
  • Analysis of outcomes data, clinical practices, and institutional variations.

Main Results:

  • Emerging evidence-based guidelines and protocols show potential to improve care and outcomes at lower gestational ages.
  • Significant practice variation, selection bias, and methodological limitations in outcomes data reporting are evident.

Conclusions:

  • Shared decision-making, prioritizing parental values, is crucial for counseling at extreme prematurity.
  • Addressing limitations in counseling, including bias and data inaccuracies, is essential.
  • Standardized perinatal outcome reporting and enhanced provider communication skills are needed.
Abstract

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