This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Critical Care/ Intensive Care Medicine  • Pediatric/ Neonatal Critical Care  • Neonatology and Infant Care  • Pediatrics, Other  • Pregnancy and Breast Feeding  • Alert me on articles by topic  Social Bookmarking   What's this?

Perspective Over a Decade

Pamela K. Donohue, ScD; Renee D. Boss, MD; Jennifer Shepard, CRNP; Ernest Graham, MD; Marilee C. Allen, MD

Arch Pediatr Adolesc Med. 2009;163(10):902-906.

Objective  To investigate prenatal management and outcome of infants born at the border of viability during 2 periods, 2001 to 2003 (late epoch) and 1993 to 1995 (early epoch).

Design  Cohort study.

Setting  Single academic, high-risk perinatal referral center.

Participants  All 160 women admitted to labor and delivery with a live fetus who delivered at an estimated gestational age of 220/7 weeks to 246/7 weeks.

Main Outcome Measures  Prenatal management and time between maternal admission and delivery or death of the fetus, infant resuscitation efforts, neonatal intensive care unit interventions, time of death, and morbidities in survivors.

Results  Mothers in both epochs were of similar age, race, and duration of pregnancy at hospital admission. Compared with the early epoch, women during the late epoch were more likely to be transported to a higher level of care (relative risk [RR], 2.01; 95% confidence interval [CI], 1.58-2.57) and receive sonographic surveillance (RR, 1.48; 95% CI, 1.07-2.04), antibiotics (RR, 1.60; 95% CI, 1.10-2.33), and antenatal steroids (RR, 1.61; 95% CI, 1.22-2.12). Life-sustaining interventions were provided for infants admitted to the neonatal intensive care unit more frequently during the late epoch than the early epoch, including high-frequency ventilation (RR, 3.57; 95% CI, 1.93-6.61), chest tubes (RR, 1.44; 95% CI, 1.06-1.94), dopamine administration (RR, 2.49; 95% CI, 1.24-4.97), and steroid administration for blood pressure support (RR, 2.18; 95% CI, 1.60-2.92). Gestational age–specific mortality was the same in the 2 epochs.

Conclusions  More interventions were provided for infants born at 22 to 24 weeks' gestation in the late epoch than the early epoch. Despite these changes in management, there has been no reduction in mortality in more than a decade.

Author Affiliations: Departments of Pediatrics (Drs Donohue, Boss, and Allen and Ms Shepard) and Gynecology and Obstetrics (Dr Graham), Johns Hopkins University School of Medicine and Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health (Dr Donohue), Baltimore, Maryland.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?