Abstract
BackgroundThere is a paucity of studies conducted in China on the outcomes of all live-birth extremely premature infants (EPIs) and there is no unified recommendation on the active treatment of the minimum gestational age in the field of perinatal medicine in China. We aimed to investigate the current treatment situation of EPIs and to provide evidence for formulating reasonable treatment recommendations.MethodsWe established a real-world ambispective cohort study of all live births in delivery rooms with gestational age (GA) between 24+0 and 27+6 weeks from 2010 to 2019.ResultsOf the 1163 EPIs included in our study, 241 (20.7%) survived, while 849 (73.0%) died in the delivery room and 73 (6.3%) died in the neonatal intensive care unit. Among all included EPIs, 862 (74.1%) died from withholding or withdrawal of care. Regardless of stratification according to GA or birth weight, the proportion of total mortality attributable to withdrawal of care is high. For infants with the GA of 24 weeks, active treatment did not extend their survival time (P = 0.224). The survival time without severe morbidity of the active treatment was significantly longer than that of withdrawing care for infants older than 25 weeks (P < 0.001). Over time, the survival rate improved, and the withdrawal of care caused by socioeconomic factors and primary nonintervention were reduced significantly (P < 0.001).ConclusionsThe mortality rate of EPIs is still high. Withdrawal of care is common for EPIs with smaller GA, especially in the delivery room. It is necessary to use a multi-center, large sample of real-world data to find the survival limit of active treatment based on our treatment capabilities.
Highlights
Premature infants (EPIs) with gestational age (GA) less than 28 weeks usually have a devastating prognosis; the phenomenon of extremely premature birth is a major cause of neonatal death worldwide [1, 2]
initial resuscitation failure (IRF), redirection of care (ROC) and maximal intensive care (MIC) were categorized as active treatment, while primary nonintervention (PNI) and socio-economic considerations (SEC) were classified as withdrawal of care [19]
In China, there is no unified recommendation on the active treatment of the minimum GA in the field of perinatal medicine
Summary
Premature infants (EPIs) with gestational age (GA) less than 28 weeks usually have a devastating prognosis; the phenomenon of extremely premature birth is a major cause of neonatal death worldwide [1, 2]. There usually exists a framework and guidelines from the ethics committee of the professional societies outlining the principles of practice Developed countries, such as France and the United Kingdom, have. World Journal of Pediatrics (2022) 18:67–74 different recommendations of active treatment or comfort care for EPIs with GA between 22 and 24 weeks [5, 11]. There is a paucity of studies conducted in China on the outcomes of all live-birth extremely premature infants (EPIs) and there is no unified recommendation on the active treatment of the minimum gestational age in the field of perinatal medicine in China. The survival time without severe morbidity of the active treatment was significantly longer than that of withdrawing care for infants older than 25 weeks (P < 0.001). It is necessary to use a multi-center, large sample of real-world data to find the survival limit of active treatment based on our treatment capabilities
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