Extremely Premature Baby Survival Still Low
Survival of extremely premature babies in a geographically defined population: prospective cohort study of 1994-9 compared with 20005 BMJ Online First (Editorial: Survival after extremely preterm birth). In the week before the House of Commons is expected to debate the time limit on abortion in the UK, a study on bmj.com reports that over the past 12 years there has been no improvement in survival of babies born before 24 weeks' gestation, the current legal limit for abortion. The authors conclude that the limits of viability for the survival of premature babies have been reached. It has been suggested that the current limit for abortion should be lowered because of continued improvements in the medical care and survival of premature babies. However, there is a lack of evidence to confirm whether survival of these babies has improved in recent years. Professor David Field and colleagues from the University of Leicester examined the survival of all babies born before 26 weeks' gestation who were alive at the onset of labour, in the Trent health region of the UK, between 1994-9 and 2000-5. The study involved 16 hospitals with over 55 000 births a year. The researchers found that despite over half the babies born at 23 weeks being admitted to intensive care, there was no improvement in survival in this group over the 12 years of the study, and only 18% (12/65) survived the stay in hospital. Importantly, during the 12 year period, care for the 150 babies born at 22 weeks remained unsuccessful, and none survived to discharge. However, the researchers report a significant improvement in the number of more mature preterm infants born at 24 and 25 weeks who survive to discharge. Of 497 babies admitted to intensive care in 2000-5, 236 (47%) survived to discharge compared with 174 of 490 (36%) in 1994-5. The authors say that their findings cannot be explained by a change in obstetric or neonatal resuscitation practice as similar numbers died in the delivery room in both time periods. Of the infants born at 22 and 23 weeks, 58% (133/229) died in the delivery room in 1994-9 and 63% (126/200) in 2000-5. The geographical region of Trent is reasonably representative of the UK as a whole, say the authors, and therefore the data is likely to similar to the outcomes of neonatal intensive care units across the UK. The authors conclude that the limits of viability for the survival of premature babies have been reached. The improved survival over time of more mature preterm infants shows how important it is to base decisions on the most up to date data possible, says an expert in an accompanying editorial. Professor Neena Modi from Imperial College London, warns that factors other than gestational age-such as sex, exposure to antenatal steroids, single or multiple birth, and birth weight- can influence survival and health outcomes. Directives on the care that should be offered to extremely preterm babies should not be based solely on gestational age, she concludes.
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Source: BMJ on May 09 2008 08:52:07 |