Active care of infants born between 22 and 26 weeks of gestation does not follow consensus expert recommendations

Ruth Sinclair; Barbara Bajuk; Robert Guaran; Daniel Challis; Joanne Sheils; Mohamed E. Abdel-Latif; Lisa Hilder; Ian M. Wright; Ju Lee Oei

doi:10.1111/apa.14714

Active care of infants born between 22 and 26 weeks of gestation does not follow consensus expert recommendations

Ruth Sinclair, Barbara Bajuk, Robert Guaran, Daniel Challis, Joanne Sheils, Mohamed E. Abdel-Latif, Lisa Hilder, Ian M. Wright, Ju Lee Oei^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

8 Citations (Scopus)

Abstract

Aim: To determine the relationship between clinical practice and publication of an Australian consensus statement for management of extremely preterm infants in 2006. Methods: A population-based study using linked data from New South Wales, Australia for births between 22 + 0 and 26 + 6 weeks of gestation between 2000 and 2011. Results: There were 4746 births of whom 2870 were liveborn and 1876 were stillborn. Of the live births, 2041 (71%) were resuscitated, 1914 (67%) were admitted into a neonatal intensive care unit (NICU) and 1310 (46%) survived to hospital discharge. Thirty-nine (2%) stillbirths were resuscitated but none survived. No 22-week infant survived to hospital discharge. Fewer 23-week gestation infants were resuscitated between 2004 (52%) and 2005 (20%) but resuscitation rates increased by 2008 (44%). There was no difference at other gestations. Adjusted odds ratio (OR) for resuscitation was increased by birthweight (OR: 1.01), tertiary hospital birth (OR: 3.4) and Caesarean delivery (OR: 11.3) and decreased by rural residence (OR: 0.4) and male gender (OR: 0.7). Conclusion: Expert recommendations may be shaped by clinical practice rather than the converse, especially for 23-week gestation infants. Recommendations should be revised regularly to include clinical practice changes.

Original language	English
Pages (from-to)	1222-1229
Number of pages	8
Journal	Acta Paediatrica, International Journal of Paediatrics
Volume	108
Issue number	7
DOIs	https://doi.org/10.1111/apa.14714
Publication status	Published - Jul 2019

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title = "Active care of infants born between 22 and 26 weeks of gestation does not follow consensus expert recommendations",

abstract = "Aim: To determine the relationship between clinical practice and publication of an Australian consensus statement for management of extremely preterm infants in 2006. Methods: A population-based study using linked data from New South Wales, Australia for births between 22 + 0 and 26 + 6 weeks of gestation between 2000 and 2011. Results: There were 4746 births of whom 2870 were liveborn and 1876 were stillborn. Of the live births, 2041 (71%) were resuscitated, 1914 (67%) were admitted into a neonatal intensive care unit (NICU) and 1310 (46%) survived to hospital discharge. Thirty-nine (2%) stillbirths were resuscitated but none survived. No 22-week infant survived to hospital discharge. Fewer 23-week gestation infants were resuscitated between 2004 (52%) and 2005 (20%) but resuscitation rates increased by 2008 (44%). There was no difference at other gestations. Adjusted odds ratio (OR) for resuscitation was increased by birthweight (OR: 1.01), tertiary hospital birth (OR: 3.4) and Caesarean delivery (OR: 11.3) and decreased by rural residence (OR: 0.4) and male gender (OR: 0.7). Conclusion: Expert recommendations may be shaped by clinical practice rather than the converse, especially for 23-week gestation infants. Recommendations should be revised regularly to include clinical practice changes.",

keywords = "Consensus statement, Delivery room resuscitation, Extremely preterm, Outcomes",

author = "Ruth Sinclair and Barbara Bajuk and Robert Guaran and Daniel Challis and Joanne Sheils and Abdel-Latif, {Mohamed E.} and Lisa Hilder and Wright, {Ian M.} and Oei, {Ju Lee}",

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AU - Bajuk, Barbara

AU - Guaran, Robert

AU - Challis, Daniel

AU - Sheils, Joanne

AU - Abdel-Latif, Mohamed E.

AU - Hilder, Lisa

AU - Wright, Ian M.

AU - Oei, Ju Lee

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N2 - Aim: To determine the relationship between clinical practice and publication of an Australian consensus statement for management of extremely preterm infants in 2006. Methods: A population-based study using linked data from New South Wales, Australia for births between 22 + 0 and 26 + 6 weeks of gestation between 2000 and 2011. Results: There were 4746 births of whom 2870 were liveborn and 1876 were stillborn. Of the live births, 2041 (71%) were resuscitated, 1914 (67%) were admitted into a neonatal intensive care unit (NICU) and 1310 (46%) survived to hospital discharge. Thirty-nine (2%) stillbirths were resuscitated but none survived. No 22-week infant survived to hospital discharge. Fewer 23-week gestation infants were resuscitated between 2004 (52%) and 2005 (20%) but resuscitation rates increased by 2008 (44%). There was no difference at other gestations. Adjusted odds ratio (OR) for resuscitation was increased by birthweight (OR: 1.01), tertiary hospital birth (OR: 3.4) and Caesarean delivery (OR: 11.3) and decreased by rural residence (OR: 0.4) and male gender (OR: 0.7). Conclusion: Expert recommendations may be shaped by clinical practice rather than the converse, especially for 23-week gestation infants. Recommendations should be revised regularly to include clinical practice changes.

AB - Aim: To determine the relationship between clinical practice and publication of an Australian consensus statement for management of extremely preterm infants in 2006. Methods: A population-based study using linked data from New South Wales, Australia for births between 22 + 0 and 26 + 6 weeks of gestation between 2000 and 2011. Results: There were 4746 births of whom 2870 were liveborn and 1876 were stillborn. Of the live births, 2041 (71%) were resuscitated, 1914 (67%) were admitted into a neonatal intensive care unit (NICU) and 1310 (46%) survived to hospital discharge. Thirty-nine (2%) stillbirths were resuscitated but none survived. No 22-week infant survived to hospital discharge. Fewer 23-week gestation infants were resuscitated between 2004 (52%) and 2005 (20%) but resuscitation rates increased by 2008 (44%). There was no difference at other gestations. Adjusted odds ratio (OR) for resuscitation was increased by birthweight (OR: 1.01), tertiary hospital birth (OR: 3.4) and Caesarean delivery (OR: 11.3) and decreased by rural residence (OR: 0.4) and male gender (OR: 0.7). Conclusion: Expert recommendations may be shaped by clinical practice rather than the converse, especially for 23-week gestation infants. Recommendations should be revised regularly to include clinical practice changes.

KW - Consensus statement

KW - Delivery room resuscitation

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Active care of infants born between 22 and 26 weeks of gestation does not follow consensus expert recommendations

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