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Perinatal care for the extremely preterm infant
Haruo Usuda1, Sean Carter2, Tsukasa Takahashi1
1Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Western Australia, 6009, Australia; Centre for Perinatal and Neonatal Medicine, Tohoku University Hospital, Sendai, 980-8574, Japan.
Insights
Periviable preterm birth, before 28 weeks gestation, is a major cause of infant mortality. This paper reviews the causes, impacts, and advanced management strategies for these extremely premature infants and their families.
Area of Science:
- Neonatology
- Perinatal Medicine
- Public Health
Background:
- Preterm birth (prior to 37 weeks gestation) causes approximately one million childhood deaths annually.
- Increasing rates of prematurity worldwide pose significant public health challenges.
- Infants born extremely preterm (less than 28 weeks gestation), especially in the periviable period (20-25 weeks), face the highest mortality and disability risks.
Purpose of the Study:
- To provide an update on the etiology and impacts of periviable preterm birth.
- To review advances in antenatal, intrapartum, and acute postnatal management of micropremmies.
- To discuss counseling and support strategies for families of infants born extremely preterm.
Main Methods:
- Literature review focusing on periviable preterm birth.
- Analysis of current clinical, technical, and ethical challenges in perinatal care.
- Exploration of emerging technologies for improving outcomes.
Main Results:
- Periviable preterm birth presents complex clinical and ethical challenges.
- Significant advancements have been made in the management of extremely preterm infants.
- Family-centered care and emerging technologies show promise for improving outcomes.
Conclusions:
- Effective management of periviable preterm birth requires a multidisciplinary approach.
- Continued research and technological innovation are crucial for reducing mortality and long-term disabilities.
- Enhanced support for families is essential throughout the perinatal care journey.
Abstract:
Being born preterm (prior to 37 weeks of completed gestation) is a leading cause of childhood death up to five years of age, and is responsible for the demise of around one million preterm infants each year. Rates of prematurity, which range from approximately 5 to 18% of births, are increasing in most countries. Babies born extremely preterm (less than 28 weeks' gestation) and in particular, in the periviable (200/7-256/7 weeks) period, are at the highest risk of death, or the development of long-term disabilities. The perinatal care of extremely preterm infants and their mothers raises a number of clinical, technical, and ethical challenges. Focusing on 'micropremmies', or those born in the periviable period, this paper provides an update regarding the aetiology and impacts of periviable preterm birth, advances in the antenatal, intrapartum, and acute post-natal management of these infants, and a review of counselling/support approaches for engaging with the infant's family. It concludes with an overview of emerging technology that may assist in improving outcomes for this at-risk population.
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