Placental histology predicted adverse outcomes in extremely premature neonates in Norway-population-based study

AIM

We evaluated the role of placental pathology in predicting adverse outcomes for neonates born extremely preterm (EPT) before 28 weeks of gestation.

METHODS

This was a prospective observational study of 123 extremely preterm singletons born in a hospital in western Norway, and the placentas were classified according to the Amsterdam criteria. The associations between histologic chorioamnionitis (HCA), by the presence or the absence of a foetal inflammatory response (FIR+ or FIR-), maternal vascular malperfusion (MVM) as a whole and adverse neonatal outcomes were evaluated by logistic regression analyses. Adverse outcomes were defined as perinatal death, necrotising enterocolitis (NEC), bronchopulmonary dysplasia (BPD), brain pathology by magnetic resonance imaging at term-equivalent age, retinopathy of prematurity and early-onset neonatal sepsis. The results are reported as odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

HCA was associated with NEC (OR 12.2, 95% CI 1.1 to 137.1). HCA/FIR+ was associated with BPD (OR 14.9, 95% CI 1.8-122.3) and brain pathology (OR 9.8, 95% CI 1.4-71.6), but HCA/FIR- was not. The only neonatal outcome that MVM was associated with was low birthweight.

CONCLUSION

Placental histology provided important information when assessing the risk of adverse neonatal outcomes following EPT birth.

The Edge of Perinatal Viability: Understanding the Dutch Position

The current Dutch guideline on care at the edge of perinatal viability advises to consider initiation of active care to infants born from 24 weeks of gestational age on. This, only after extensive counseling of and shared decision-making with the parents of the yet unborn infant. Compared to most other European guidelines on this matter, the Dutch guideline may be thought to stand out for its relatively high age threshold of initiating active care, its gray zone spanning weeks 24 and 25 in which active management is determined by parental discretion, and a slight reluctance to provide active care in case of extreme prematurity. In this article, we explore the Dutch position more thoroughly. First, we briefly look at the previous and current Dutch guidelines. Second, we position them within the Dutch socio-cultural context. We focus on the Dutch prioritization of individual freedom, the abortion law and the perinatal threshold of viability, and a culturally embedded aversion of suffering. Lastly, we explore two possible adaptations of the Dutch guideline; i.e., to only lower the age threshold to consider the initiation of active care, or to change the type of guideline.

Opinions on the counselling, care and outcome of extremely premature birth among healthcare professionals in Finland

AIM

To study the opinions of paediatric and obstetric personnel on the perinatal treatment and delivery outcome of infants from 22(+0) to 27(+6)  weeks' gestation.

METHODS

An email questionnaire was sent to 2963 professionals in 32 maternity hospitals in Finland.

RESULTS

The questionnaire survey was completed by 856 (28%) professionals in 30 hospitals. Opinions on outcome were most pessimistic if the infant was very premature. More than a third (37%) assumed no survival at the earliest gestational age, but none dismissed the possibility at 26 weeks' gestation. Paediatric professionals took a more active approach to the treatment of a premature birth and baby than obstetric personnel. Opinions on treatment activity were based firstly on what was best for the baby and secondly on experience. Gynaecologists reported discussing matters regarding premature birth with the parents more often than paediatricians and were much more likely to be influenced by these discussions.

CONCLUSION

Paediatric personnel showed a more positive attitude and a more active approach to extremely premature deliveries and babies than obstetric personnel. There would appear to be some inconsistency between prenatal counselling and treatment activity after birth at the limit of viability.