(From the November 2015 Issue of PediatricsOnline)
Denise Foyle had been pregnant for just 23 weeks when she gave birth to her daughter, Bryn. She weighed one pound and three ounces, and measured only 12 inches long.
“If you saw Bryn today at age two, other than her being a little small, you would have no idea that she was fighting for her life in the neonatal intensive care unit for more than five months,” said Denise Foyle. “She’s a normal preschooler who dances and knows her ABCs.”
According to clinician-scientists at Nationwide Children’s Hospital and The Ohio State University Wexner Medical Center, there are striking differences across U.S. hospitals in the decision to initiate or withhold treatment at 23 weeks of gestation. The researchers’ new retrospective study, published in Obstetrics & Gynecology, looked at 101 infants born at 23 weeks gestation between 2004 and 2013 who received comprehensive perinatal and neonatal care. Sixty infants survived to hospital discharge and more than half of the survivors evaluated at 18 to 22 months had little to no neurological complications.
“Our collaborative team at Nationwide Children’s Hospital and The Ohio State University are committed to providing the best possible care and counseling of families facing the birth of a premature infant. This study is a small step forward in providing parents with more accurate information to help them make informed decisions about the care of their child,” said Carl Backes, MD, a neonatologist and cardiologist at Nationwide Children’s. “The goal of our team at Nationwide Children’s and The Ohio State University is to provide the best care possible, and we believe that starts with optimize care and counseling of families facing the birth of extremely premature neonates.”
The study looked at multiple interventions that can affect outcomes from both obstetrical and neonatal perspectives, including prenatal care, preterm labor, preterm premature rupture of membranes, surfactants in the delivery room and prolonged intubation sequences, to name a few.
“The goal of our care team for births at 23 week, whether anticipated or imminent, is to support families by supporting shared decision-making between families and health care providers,” said Stacy Beck, MD, maternal fetal medicine physician at The Ohio State University Wexner Medical Center. “From an obstetrician perspective, when prenatal counseling is possible, we can improve the efficiency of care in the delivery room for these babies born extremely premature.”
A typical pregnancy lasts about 40 weeks and the limits of viability are considered to be 22-23 weeks. In past literature, a majority of babies born at 23 weeks have not survived, or had moderate impairment.
“The difference with our study was that obstetricians, neonatologists and families were all on the same page,” said Leif Nelin, MD, Dean W Jeffers Chair of Neonatology at Nationwide Children’s and a professor of Pediatrics at The Ohio State University College of Medicine. “However, our study only describes outcomes in a best-case scenario, as all the neonates were all singleton pregnancies with time for prenatal counseling, which is not always the case. Larger studies are needed to confirm these findings, and it should be noted that developmental assessments at 18-22 months may not fully predict outcomes later in childhood.”
Nationwide Children’s has ongoing courses intended for providers throughout central Ohio on the care of the extremely premature neonate in the delivery room and first 24 hours of birth.
Backes CH, Rivera BK, Haque U, Srouji L, Beck S, Yin H, Smith CV, Iams JD, Nelin LD. A Proactive Approach to Neonates Born at 23 Weeks of Gestation. Obstetrics & Gynecology. 2015 Oct 5 [Epub ahead of print].