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• Time to explore the variation in outcome at 22-23 weeks
  Archana Mishra
  Published on: 19 April 2018

• Published on: 19 April 2018

  Time to explore the variation in outcome at 22-23 weeks

  • Archana Mishra, Consultant Neonatologist Bolton NHS Foundation Trust

  I congratulate the authors for putting the results of this much needed study together and exploring the differences in survival for extremely preterm babies at 22-23 weeks. The outcome for babies born at < 26 weeks hasn't been looked at nationally since the EPICURE 2 study in 2006.
  It is interesting to note the regional variation in survival at 22-23 weeks and it warrants further exploring the following issues:
  1. Is there a variation nationally in administering antenatal steroids at <24 weeks gestation? The NICE guideline 2015 advocates:
  For women between 23+0 and 23+6 weeks of pregnancy who are in suspected or established preterm labour, are having a planned preterm birth or have P-PROM, discuss with the woman (and her family members or carers as appropriate) the use of maternal corticosteroids in the context of her individual circumstances. This is open to interpretation and may not provide consistency in administration of antenatal steroids at 23 to 23+6 weeks. There is no guidance for <23 weeks. It will be useful to explore the practice nationally.
  2. The practice for resuscitation at <23 weeks is likely to be variable. The latest national guideline BAPM 2008 advocates If gestational age is certain and less than 23+0 (i.e. at 22 weeks) it would be considered in the best interests of the baby, and standard practice, for resuscitation not to be carried out. The units who were resuscitating babies <23 weeks were deviating from...

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  I congratulate the authors for putting the results of this much needed study together and exploring the differences in survival for extremely preterm babies at 22-23 weeks. The outcome for babies born at < 26 weeks hasn't been looked at nationally since the EPICURE 2 study in 2006.
  It is interesting to note the regional variation in survival at 22-23 weeks and it warrants further exploring the following issues:
  1. Is there a variation nationally in administering antenatal steroids at <24 weeks gestation? The NICE guideline 2015 advocates:
  For women between 23+0 and 23+6 weeks of pregnancy who are in suspected or established preterm labour, are having a planned preterm birth or have P-PROM, discuss with the woman (and her family members or carers as appropriate) the use of maternal corticosteroids in the context of her individual circumstances. This is open to interpretation and may not provide consistency in administration of antenatal steroids at 23 to 23+6 weeks. There is no guidance for <23 weeks. It will be useful to explore the practice nationally.
  2. The practice for resuscitation at <23 weeks is likely to be variable. The latest national guideline BAPM 2008 advocates If gestational age is certain and less than 23+0 (i.e. at 22 weeks) it would be considered in the best interests of the baby, and standard practice, for resuscitation not to be carried out. The units who were resuscitating babies <23 weeks were deviating from the national guidance and it would be useful to explore the reasons to do so.
  3. It will be important to monitor the developmental outcomes of babies < 23 weeks gestation. This will be useful to influence decision making in resuscitation and management for this group nationally.

  The authors may already be looking to explore these issues as it will be important to put in context the variation in practice for management of extremely preterm babies at 22-23 weeks gestation.

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  Conflict of Interest:
  None declared.

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