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Title: Guidelines for the Management of Extremely Premature Deliveries: A Systematic Review.
Authors: Guillén, Ú.
Weiss, E. M.
Munson, D.
Maton, P.
Jefferies, A.
Norman, M.
Naulaers, G.
Mendes, J.
Justo da Silva, L.
Zoban, P.
Hansen, T. W.
Hallman, M.
Delivoria-Papadopoulos, M.
Hosono, S.
Albersheim, S. G.
Williams, C.
Boyle, Elaine
Lui, K.
Darlow, B.
Kirpalani, H.
First Published: 13-Jul-2015
Publisher: American Academy of Pediatrics
Citation: Pediatrics, 136(2), August 2015
Abstract: BACKGROUND AND OBJECTIVES: Available data on survival rates and outcomes of extremely low gestational age (GA) infants (22-25 weeks' gestation) display wide variation by country. Whether similar variation is found in statements by national professional bodies is unknown. The objectives were to perform a systematic review of management from scientific and professional organizations for delivery room care of extremely low GA infants. METHODS: We searched Embase, PubMed, and Google Scholar for management guidelines on perinatal care. Countries were included if rated by the United Nations Development Programme's Human Development Index as "very highly developed." The primary outcome was rating of recommendations from "comfort care" to "active care." Secondary outcomes were specifying country-specific survival and considering potential for 3 biases: limitations of GA assessment; bias from different definitions of stillbirths and live births; and bias from the use of different denominators to calculate survival. RESULTS: Of 47 highly developed countries, 34 guidelines from 23 countries and 4 international groups were identified. Of these, 3 did not state management recommendations. Of the remaining 31 guidelines, 21 (68%) supported comfort care at 22 weeks' gestation, and 20 (65%) supported active care at 25 weeks' gestation. Between 23 and 24 weeks' gestation, much greater variation was seen. Seventeen guidelines cited national survival rates. Few guidelines discussed potential biases: limitations in GA (n = 17); definition bias (n = 3); and denominator bias (n = 7). CONCLUSIONS: Although there is a wide variation in recommendations (especially between 23 and 24 weeks' GA), there is general agreement for comfort care at 22 weeks' GA and active care at 25 weeks' GA.
DOI Link: 10.1542/peds.2015-0542
ISSN: 0031-4005
eISSN: 1098-4275
Embargo on file until: 1-Jan-10000
Version: Post-print
Status: Peer-reviewed
Type: Journal Article
Rights: Copyright © 2015 by the American Academy of Pediatrics
Appears in Collections:Published Articles, Dept. of Health Sciences

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International Guidelines GA_figureFINAL.JPGPost-review (final submitted)228.86 kBJPEGThumbnail
International Guidelines Pediatrics_revision 04 20 15 (1).pdfPost-review (final submitted)270.27 kBAdobe PDFView/Open
Table 1_Pediatrics_merged (1).pdfPost-review (final submitted)191.85 kBAdobe PDFView/Open
Table 2_Pediatrics_survivalrates.pdfPost-review (final submitted)176.25 kBAdobe PDFView/Open

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