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Perinatal optimisation for periviable birth and outcomes: a 4-year network analysis (2018-2021) across a change in
J Peterson1,2, D M Smith1, E D Johnstone1,2
1Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
Insights
The British Association of Perinatal Medicine framework revision increased perinatal optimisation for extremely preterm infants. Survival-focused care expanded to 22-week infants, but survival rates remain static at the lowest gestations.
Area of Science:
- Neonatal Medicine
- Perinatal Care
- Public Health Policy
Background:
- The British Association of Perinatal Medicine (BAPM) updated its framework in 2019, recommending survival-focused care for infants from 22 weeks gestation.
- This marked a shift from previous guidelines that suggested comfort care for infants under 23 weeks + 0 days.
Purpose of the Study:
- To evaluate the clinical impact of the revised BAPM framework in Northwest England.
- To examine changes in perinatal optimisation and survival outcomes for periviable infants.
Main Methods:
- Utilised anonymised network data from periviable infants delivered in Northwest England.
- Analysed changes in care practices and survival rates post-BAPM framework update.
Main Results:
- Observed an increase in perinatal optimisation practices for periviable infants.
- Documented an 80% rise in survival-focused care and neonatal unit admissions for infants born at 22 weeks gestation.
Conclusions:
- The updated BAPM framework has led to increased optimisation and survival-focused care for periviable infants, particularly at 22 weeks gestation.
- Discrepancies in optimisation by gestational age persist, potentially impacting static survival rates at the lowest gestations.
Introduction:
The British Association of Perinatal Medicine (BAPM) released their revised framework for extremely preterm infant management in 2019. This revised framework promotes consideration of perinatal optimisation and survival-focused care from 22 weeks gestation onwards. This was a departure from the previous BAPM framework which recommended comfort care as the only recommended management for infants <23 + 0 weeks.
Methods:
Our study evaluates the clinical impact that this updated framework has had across the Northwest of England. We utilised anonymised network data from periviable infants delivered across the region to examine changes in perinatal optimisation practices and survival outcomes following the release of the latest BAPM framework.
Results:
Our data show that after the introduction of the updated framework there has been an increase in perinatal optimisation practices for periviable infants and an 80% increase in the number of infants born at 22 weeks receiving survival-focused care and admission to a neonatal unit.
Discussion:
There remain significant discrepancies in optimisation practices by gestational age, which may be contributing to the static survival rates that were observed in the lowest gestational ages.
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