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I read with interest the case report titled “Two-Year Neurodevelopmental Outcome of an Infant Born at 21 Weeks’ 4 Days’ Gestation”, a report of an infant who was born at 21 weeks of gestational age, was discharged before corrected term gestation and had very impressive developmental outcomes at 20 months of corrected age (Ahmad, K.A. 2017). Congratulations to the family and hard working group involved in management of this child!! The authors have stated correctly that we should refrain from drawing conclusion based on one care report. The article raises many questions.
1) The authors reported that they had started resuscitation after five minutes of life despite having no spontaneous movement. Was resuscitation team present in the delivery room prior to delivery of the infant or they were called in after the delivery when parents requested for resuscitation? If the team was present for delivery, is it common practice in your intuition? If team was not present at delivery, how often do you get calls in similar situations and how do you procced?
2) Currently there is not a single marker of success transition from intrauterine to extra uterine life and gestation age is most commonly used indicator to decide viability. American academy of pediatrics, American college of obstetrics and gynecology (ACOG) and other organizations have not recommended performing resuscitation to infants born at 21 weeks of life (Obstetric care consensus 2016) (ACOG Committee on O...
2) Currently there is not a single marker of success transition from intrauterine to extra uterine life and gestation age is most commonly used indicator to decide viability. American academy of pediatrics, American college of obstetrics and gynecology (ACOG) and other organizations have not recommended performing resuscitation to infants born at 21 weeks of life (Obstetric care consensus 2016) (ACOG Committee on Obstetric Practice 2016) ( Cummings, J. 2015) (Guillen, U. 2015). The authors resuscitated infant born at 21 weeks of gestations. How often the authors and their institutions offer resuscitation to the infants born at this gestational age? If this is the only case, the authors have not reported why did they deviate from their practice. If they have done resuscitation to other infants born at this gestation age, selective reporting of case with desirable outcomes introduces biases.
3) One case report is not enough to change the practice in general but will certainly be enough to boosts the satisfaction and confidence of the group. Have your team and intuition made any changes in prenatal counseling and management practice of periviable infants after this case?
1. Obstetric care consensus no. 4: Periviable birth. Obstet Gynecol. 2016;127(6):e157-69. doi: 10.1097/AOG.0000000000001483 [doi].
2. Ahmad KA, Frey CS, Fierro MA, Kenton AB, Placencia FX. Two-year neurodevelopmental outcome of an infant born at 21 weeks' 4 days' gestation. Pediatrics. 2017. doi: e20170103 [pii].
3. American College of Obstetricians and Gynecologists' Committee on Obstetric Practice, Society for Maternal- Fetal Medicine. Committee opinion no.677: Antenatal corticosteroid therapy for fetal maturation. Obstet Gynecol. 2016;128(4):e187-94. doi: 10.1097/AOG.0000000000001715 [doi].
4. Cummings J, COMMITTEE ON FETUS AND NEWBORN. Antenatal counseling regarding resuscitation and intensive care before 25 weeks of gestation. Pediatrics. 2015;136(3):588-595. doi: peds.2015-2336 [pii].
5. Guillen U, Weiss EM, Munson D, et al. Guidelines for the management of extremely premature deliveries: A systematic review. Pediatrics. 2015;136(2):343-350. doi: 10.1542/peds.2015-0542 [doi].
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