Variation in care for extremely preterm infants

Last week a new article came out in the New England Journal of Medicine about differences in the way 22-week preemies are treated. Many hospitals won’t even try, even if the parents ask for it. This excellent blog post from Keith Barrington is from a couple of years ago about some other articles that have been done on the treat / don’t treat question.

Neonatal Research

One of the things that is striking in neonatology are the variations in outcomes of the most immature babies. In some centers, and in some countries, when a mother presents with threatened delivery at what the doctors think is 23 or at 24 weeks gestation (which we don’t actually know very precisely) the babies are not offered active care. Other places discourage active intervention, while others are more open, or actively encourage institution of life support.

Not surprisingly if you don’t offer intensive care the babies die. Then you can honestly go to the parents and say ‘we don’t offer intensive care because all these babies die’. On the other hand if you are active at 24 weeks gestation, then overall survival can be over 2/3. Then you can go to the parents and say ‘we routinely start intensive care because the majority of the babies survive’. So the attitudes…

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