Published online September 30, 2005
PEDIATRICS Vol. 116 No. 4 October 2005, pp. 1053-1054 (doi:10.1542/peds.2005-0881)
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Ensuring Accurate Knowledge of Prematurity Outcomes for Prenatal Counseling

William MacKendrick, MD
Michael Caplan, MD
Department of Pediatrics,
Evanston Northwestern Healthcare,
Evanston, IL 60201,
Northwestern University Feinberg School of Medicine,
Chicago, IL 60611-3008

To the Editor.—

Counseling parents who are faced with the imminent delivery of an extremely premature infant is an extraordinarily challenging and stressful process for parents and caregivers. We agree with Blanco et al1 that an accurate knowledge of outcomes is a critical component of the counseling process, but we have concerns about the authors' use of multicenter, aggregated outcomes data for counseling at a particular institution. Outcomes data at a particular institution may vary widely from those reported from multicenter databases2,3 for a variety of reasons including patient demographics and local care practices. Aggregated data are useful for benchmarking of local results, but it seems intuitive that local data, if sufficiently robust and reliable, should be used for counseling. In addition, the authors synthesized long-term disability rates by combining data from several outcomes studies that had varying durations of follow-up. Ment et al4 have demonstrated that very low birth weight infants tend to have significant improvement in cognitive function until at least 8 years of age, suggesting that comparison of disability rates at different chronologic ages may be misleading.

The authors also state that "[t]here seems to be sufficient evidence now to establish the limit of viability in the United States at 23 weeks of gestation."1 We agree that there are no data suggesting that infants born at <23 weeks' gestation should be considered to be viable, but the available outcomes data for infants born at 23 weeks' gestation are also not encouraging. We view decision-making for resuscitation of infants born at 23 and 24 weeks' gestation as a joint process to be worked through with the family. The decision reached will vary, and it will be influenced heavily by the values and perceptions of the family. Provision of life support to infants born at the threshold of viability is not a black-and-white decision made by using a strict gestational-age cutoff as the authors seem to imply in their statement.

REFERENCES

  1. Blanco F, Suresh G, Howard D, Soll RF. Ensuring accurate knowledge of prematurity outcomes for prenatal counseling. Pediatrics. 2005;115 (4). Available at: www.pediatrics.org/cgi/content/full/115/4/e478
  2. Hoekstra RE, Ferrara TB, Couser RJ, Payne NR, Connett JE. Survival and long-term neurodevelopmental outcome of extremely premature infants born at 23–26 weeks' gestational age at a tertiary center. Pediatrics. 2004;113 (1). Available at: www.pediatrics.org/cgi/content/full/113/1/e1
  3. Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. Neurologic and developmental disability after extremely preterm birth. N Engl J Med. 2000;343 :378 –384[Abstract/Free Full Text]
  4. Ment LR, Vohr B, Allan W, et al. Change in cognitive function over time in very low-birth-weight infants. JAMA. 2003;289 :705 –711[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2005 by the American Academy of Pediatrics

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This Article
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