[Perinatal policy in cases of extreme prematurity; an investigation into the implementation of the guidelines].
OBJECTIVE
To determine to what extent the recommendations to actively treat preterm infants with a gestational age of 24 weeks upwards laid down in the guidelines 'Perinatal policy in cases of extreme prematurity' have influenced policy in Dutch perinatal centres in the first year after publication, and what the health outcomes were.


METHODS
Retrospective, descriptive study.


METHODS
Our study population included all pregnant women who were admitted to a perinatal centre at 23 5/7 to 26 weeks gestation with a diagnosis of 'threatened preterm labour', and their preterm infants. We collected both obstetric data and data on survival and morbidity of the infants from the medical files.


RESULTS
Of a total of 192 preterm infants 185 (96%) were born alive; 92% of these infants were admitted to the neonatal intensive care unit. Survival rates were 43% and 61% at 24 weeks and 25 weeks gestation, respectively. Short-term morbidity (bronchopulmonary dysplasia, retinopathy of the newborn, severe intraventricular haemorrhage, necrotising enterocolitis and persistent ductus arteriosus) occurred in 79% and 71% of the infants born at 24 weeks and 25 weeks gestation, respectively.


CONCLUSIONS
The recommendations from these guidelines have been implemented swiftly in Dutch perinatal centres, and survival of extremely preterm infants has increased. This has imposed a considerable burden on the capacity of these centres. Little is yet known about the long-term (up to school-age) health and survival of these infants.
* Namens de Implementatiegroep Richtlijn Extreem Prematuren, waarvan de samenstelling vermeld staat aan het eind van dit artikel.
Evelyne
E
de Kluiver
Martin
M
Offringa
Frans J
FJ
Walther
Johannes J
JJ
Duvekot
Monique W M
MW
de Laat
D000328:Adult; D002585:Cesarean Section / Q000706:statistics & numerical data; D002648:Child; D005260:Female; D005865:Gestational Age; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000401:mortality* / Q000517:prevention & control; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000592:standards* / Q000706:statistics & numerical data; D009017:Morbidity; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D012189:Retrospective Studies; D015996:Survival Rate