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Have the boundaries of the 'grey zone' of perinatal resuscitation changed for extremely preterm infants over 20 years?
MedLine Citation:
PMID:  23211016     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: As the likelihood of survival improves over time, the BW- and GA-specific boundaries of discretionary non-resuscitation should fall. HYPOTHESIS: Between 1988 and 2008 reductions in BW- and GA- specific mortality would drive a parallel reduction in BW and GA boundaries of discretionary resuscitation. METHODS: We determined the likelihood of resuscitation and survival to NICU discharge for all infants born <700g or <26 gestational weeks from 1988-2008. In addition, for 1988, 1993, 1998, 2003, and 2008, we determined the BW and GA for the 10 smallest infants who were resuscitated, and the 10 largest infants who were not resuscitated. We excluded any infant born with congenital anomaly. RESULTS: Mortality fell from 80% in 1988 to 28% in 2008, and as expected, the percentage who were resuscitated rose from 63% in 1988-93 to 95% in 2004-2008. However, unexpectedly, over the 20-year study period the smallest infants who were resuscitated despite extreme immaturity did not change (450-550g and 23-24 weeks), and the largest infants not resuscitated did not change (600-700g and 23-24 weeks. CONCLUSION: Neither the BW nor GA boundaries of the grey zone of discretionary resuscitation have fallen over the past 20 years. Factors guiding resuscitation at the border of viability are complex, and incompletely understood. ©2012 The Author(s)/Acta Paediatrica ©2012 Foundation Acta Paediatrica.
Authors:
Joy Condie; Leslie Caldarelli; Lindsay Tarr; Cathy Gray; Teresa Rodriquez; John Lantos; William Meadow
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-12-4
Journal Detail:
Title:  Acta paediatrica (Oslo, Norway : 1992)     Volume:  -     ISSN:  1651-2227     ISO Abbreviation:  Acta Paediatr.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-5     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9205968     Medline TA:  Acta Paediatr     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
©2012 The Author(s)/Acta Paediatrica ©2012 Foundation Acta Paediatrica.
Affiliation:
Department of Pediatrics, The University of Chicago, Chicago, IL.
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