Delivery room management of extremely preterm infants: the EPIPAGE-2 study. Issue 5 (2nd February 2016)

• Record Type: Journal Article
• Authors: Perlbarg, J; Ancel, P Y; Khoshnood, B; Durox, M; Boileau, P; Garel, M; Kaminski, M; Goffinet, F; Foix-L'Hélias, L
• Other Names: author non-byline.; Kuhn Pierre author non-byline.; Langer Bruno author non-byline.; Mazille Nadia author non-byline.; Lecomte Bénédicte author non-byline.; Bellot Anne author non-byline.; Dupont-Chauvet Peggy author non-byline.; Betremieux Pierre author non-byline.; Beuchée Alain author non-byline.; Charlot Frédérique author non-byline.; Rouget Florence author non-byline.; Thiriez Gérard author non-byline.; Anselem Olivia author non-byline.; Azria Elie author non-byline.; Boujenah Laurence author non-byline.; Caeymaex Laurence author non-byline.; Jarreau Pierre-Henri author non-byline.; Magny Jean-François author non-byline.; Mokhtari Mostafa author non-byline.; Jacquot Aurélien author non-byline.; Lemaître Anne author non-byline.; Miler Caroline author non-byline.; Vieux Rachel author non-byline.; Arnaud Catherine author non-byline.; Truffert Patrick author non-byline.; Simeoni Umberto author non-byline.; Bouderlique-Collin Claude author non-byline.; Chauty Anne author non-byline.; Savagner Christophe author non-byline.; Claris Olivier author non-byline.; Coquelin Anaëlle author non-byline.;
• Is Part Of: Archives of disease in childhood. Volume 101:Issue 5(2016)
• Page Start: F384
• Page End: F390
• Publication Date: 2016-02-02
• Subjects: Neonatology -- Epidemiology; Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2015-308728
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : Objective: To analyse the delivery room management of babies born between 22 and 26 weeks of completed gestational age and to identify the factors associated with the withholding or withdrawal of intensive care. Study design: Population-based cohort study. Patients and methods: Our study population comprised 2145 births between 22 and 26 completed weeks enrolled in the EPIPAGE-2 study, a French cohort of very preterm infants born in 2011. The primary outcome measure was withholding or withdrawal of intensive care in the delivery room. Results: Among infants born alive at 22–23 weeks, intensive care was withheld or withdrawn for >90%. At 24 weeks, resuscitative measures were withheld or withdrawn for 38%, at 25 weeks for 8% and at 26 weeks for 3%. Other factors besides gestational age at birth associated with this withholding or withdrawal for infants born at 24–26 weeks were birth weight <600 g, emergency delivery (within 24 h of the mother's admission) and singleton pregnancy. Although rates of withholding or withdrawal of intensive care varied substantially between maternity units (from 0% to 100%), the variability was primarily explained by differences in distributions of gestational age at birth. Conclusions: Although gestational age is only one factor predicting survival of preterm infants, practices in France appear to be based primarily on this factor, which thus has direct effects on the survival of extremely preterm infants. The ethical implications of basing life and death decisions only on gestational age before 25 weeks require further examination.