Outcomes following periviable birth.
This review is presented in three segments: (1) important background concepts, (2) recent reports from regional geographically defined cohorts, and (3) prognosis research from the National Institutes of Health Neonatal Research Network. Extending the use of intensive care to newborns of lower gestational ages will unavoidably result in a higher proportion and a higher absolute number of survivors with morbidity, unless other changes in practice offset the increased risk associated with decreasing gestational age. In geographically defined cohort studies, the proportion of periviable newborns delivered in perinatal centers and the practices around foregoing and withdrawing intensive care are two important determinants of outcomes following periviable birth. It is much easier to quantify the effect of the former than the latter. Decisions regarding comfort care vs. intensive are frequently based on gestational age as the sole predictor variable, although multiple factors can be readily used to more accurately assess the benefits and burdens of intensive care and facilitate better informed parental counseling and decision making.
Department of Pediatrics, University of Texas Health Science Center at Houston Medical School, 6431 Fannin, St, MSB 3.242, Houston, TX 77030. Electronic address: Cody.C.Arnold@uth.tmc.edu.
Cody
C
Arnold
Center for Clinical Research & Evidence-Based Medicine, University of Texas Health Science Center at Houston Medical School, Houston, TX.
Jon E
JE
Tyson
D003657:Decision Making; D037001:Directive Counseling / Q000379:methods; D005260:Female; D005328:Fetal Viability; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D015931:Intensive Care, Neonatal; D010166:Palliative Care; D010290:Parents / Q000523:psychology; D010353:Patient Education as Topic; D011247:Pregnancy; D047928:Premature Birth; D011379:Prognosis; D016414:Resuscitation Orders / Q000941:ethics; D015996:Survival Rate