No Standard Treatment for Extreme Premature Babies

A new study reveals that hospital practices vary widely in initiating active treatment in extremely preterm infants.

Researchers at the University of Iowa (Iowa City, USA), Wayne State University (Detroit, MI, USA), and other institutions conducted a study involving infants born between April 2006 and March 2011 at 24 hospitals. Excluding infants with congenital anomalies, 4,987 babies born before reaching 27 weeks of gestation were included in the analysis. Of these, 4,329 babies received active treatment, and outcomes were known for 4,704; active treatment was defined as any potentially lifesaving intervention administered after birth.

The results showed that the overall rates of active treatment ranged from 22.1% among infants born at 22 weeks of gestation to 99.8% among those born at 26 weeks of gestation. Active treatments included surfactant therapy, tracheal intubation, ventilatory support, parenteral nutrition, epinephrine, or chest compressions. Babies who did not receive active treatment tended to be small for their age, have one-minute Apgar scores of 3 or lower, and were less likely to have antenatal glucocorticoids or have been delivered by cesarean section.

The researchers also assessed survival and survival without severe neurological impairment once the babies reached 18–22 months of corrected age. Babies born at 26 weeks demonstrated an 81.4% survival rate, and a 75.6% rate of survival without severe impairment. For 22-week-old babies who were given active treatment, the rate of survival was 23.1%, the rate of survival without severe impairment was 15.4%, and the rate of survival without severe or moderate impairment was 9%. The study was published on May 7, 2015, in the New England Journal of Medicine (NEJM).

“Sometimes tiny babies with zero chance of surviving show signs of life at birth, and may be able to breathe for a short time if put in an incubator and hooked up to a breathing machine and intravenous treatments,” said study coauthor professor of pediatrics Edward Bell, MD. “But even so, if it's a baby that doesn't have a chance, we don't want to put the baby and the family through the discomfort. These are very difficult decisions and they need to be made on a case-by-case basis by the families and physicians.”

An estimated 15 million babies are born too early every year, and almost one million of them die each year due to complications of preterm birth. Many survivors face a lifetime of disability, including learning disabilities and visual and hearing problems. Globally, prematurity is the leading cause of death in children under the age of 5. And in almost all countries with reliable data, preterm birth rates are increasing. More than three-quarters of premature babies can be saved with feasible, cost-effective care, such as antenatal steroid injections to strengthen the babies’ lungs and antibiotics to treat newborn infections.

Related Links:
University of Iowa
Wayne State University