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Survival in Extreme Preterm Infants Unchanged Since 1993

In those born before 24 weeks' gestation, survival time, but not overall survival, has increased

TUESDAY, April 27 (HealthDay News) -- Since 1993, more infants born at less than 24 weeks' gestation have lived more hours or even days thanks to active resuscitation, but overall survival has not improved, according to a report published online April 22 in the Archives of Disease in Childhood: Fetal & Neonatal Edition.

Ravi Swamy, of the Royal Victoria Infirmary in Newcastle upon Tyne, U.K., and colleagues analyzed data from the Perinatal Mortality Survey on 229 infants born alive at 22 or 23 weeks' gestation between 1993 and 2007. The researchers divided the study period into three cohorts: 1993 to 1997, 1998 to 2002, and 2003 to 2007.

The authors note that, during the entire study period, 210 infants (92 percent) died, and 19 infants (8 percent) survived. Of the infants who died, 34 percent survived longer than six hours. Among infants who received active resuscitation and were alive at six hours, but ultimately died, the median age at death was 11 hours in 1993 to 1997, 20 hours in 1998 to 2002, and 3.7 days in 2003 to 2007. Among the 19 infants who ultimately survived, six were from 1993 to 1997, six from 1998 to 2002, and seven from 2003 to 2007. Of the seven infants who survived in the last time period, four required surgical procedures.

"Some will feel that the prolonged periods of intensive, but unsuccessful, care demonstrated in this report are either futile or inappropriate. An improved understanding of societal and parental attitudes and perceptions towards either the withholding or the withdrawing of active treatment at the margins of viability is needed," the authors conclude.

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