RT Journal Article
SR Electronic
T1 Delivery room management of extremely preterm infants: the EPIPAGE-2 study
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP F384
OP F390
DO 10.1136/archdischild-2015-308728
VO 101
IS 5
A1 J Perlbarg
A1 P Y Ancel
A1 B Khoshnood
A1 M Durox
A1 P Boileau
A1 M Garel
A1 M Kaminski
A1 F Goffinet
A1 L Foix-L'Hélias
A1 the Epipage-2 Ethics group
YR 2016
UL http://fn.bmj.com/content/101/5/F384.abstract
AB 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of intensive care in the delivery room.Results Among infants born alive at 22–23 weeks, intensive care was withheld or withdrawn for 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 At 24 weeks, resuscitative measures were withheld or withdrawn for 38%, at 25 weeks for 8% and at 26 weeks for 3%.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.