Guideline change affected outcomes for very premature babies

Survival among very premature babies has risen following recent guideline changes in England and Wales, according to an analysis published today.

The guidance was altered in 2019 to recommend “extended provision of survival focused care” for babies born at 22 weeks’ gestation.

A team led by Professor Lucy Smith at the University of Leicester, UK, used routine hospital records on 1,001 babies born at 22 weeks since the changes, and compared them to babies born at 23 and 24 weeks.

Survival focused care included active respiratory support after birth and admittance to neonatal care.

Results showed a threefold increase in provision of this care, up from 11% to 38%. Survival to discharge from neonatal care also rose, from 3% to 8%.

“More babies of lower birth weight and early gestational age received survival focused care in 2020 to 21 than 2018 to 19,” report the team in BMJ Medicine.

They state: “A change in national guidance to recommend a risk based approach was associated with a threefold increase in 22 weeks’ gestation babies receiving survival focused care.

“The number of babies being admitted to neonatal units and those surviving to discharge increased. These rapid and substantial changes were associated with the introduction of the British Association of Perinatal Medicine guidance.”

However, they add that overall survival remains low and there are implications for additional resource needs. “This result also means that the number of babies who died after intensive care also increased,” they point out.

“Maternity care was also affected because of likely increases in in-utero transfers (ie, moved to a specialist hospital before birth), as well as impacts on paediatric and educational services to provide for long term health and developmental needs.”

Smith, L. K. et al. Effect of national guidance on survival for babies born at 22 weeks’ gestation in England and Wales: population based cohort study. BMJ Medicine 8 November 2023 doi: 10.1136/bmjmed-2023-000579


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