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Delivery room management of extremely preterm infants: the EPIPAGE-2 study
  1. J Perlbarg1,
  2. P Y Ancel1,2,
  3. B Khoshnood1,
  4. M Durox1,
  5. P Boileau3,4,
  6. M Garel1,
  7. M Kaminski1,
  8. F Goffinet1,5,
  9. L Foix-L'Hélias1,6,
  10. the Epipage-2 Ethics group
    1. 1Obstetrical Perinatal and Pediatric Epidemiology Team, Epidemiology and Biostatistics Sorbonne Paris Cité Research Center (U1153), INSERM, Paris, France
    2. 2URC-CIC P1419, DHU Risk in Pregnancy, Cochin Hôtel-Dieu Hospital, APHP, Paris, France
    3. 3Neonatal Intensive Care Unit, CHI Poissy Saint-Germain-en-Laye, Poissy, France
    4. 4EA 7285, Versailles Saint-Quentin-en-Yvelines University, Versailles, France
    5. 5Maternité Port-Royal, Paris-Descartes University, Cochin Broca Hôtel-Dieu Hospital, Assistance Publique-Hôpitaux de Paris, DHU Risk in Pregnancy, Paris, France
    6. 6Service de Néonatologie, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France
    1. Correspondence to Julie Perlbarg, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Statistics, Sorbonne Paris Cité Research Center (U1153), Inserm, 4, rue de la Chine, 75020 Paris, France; julieperlbarg{at}gmail.com

    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    Results Among infants born alive at 22–23 weeks, intensive care was withheld or withdrawn for 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 At 24 weeks, resuscitative measures were withheld or withdrawn for 38%, at 25 weeks for 8% and at 26 weeks for 3%.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.

    • Neonatology
    • Epidemiology

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