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Practice Clinical Updates

Management and outcomes of extreme preterm birth

BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2021-055924 (Published 10 January 2022) Cite this as: BMJ 2022;376:e055924
  1. Andrei S Morgan, neonatologist and epidemiologist1 2 3,
  2. Marina Mendonça, lecturer in psychology4 5,
  3. Nicole Thiele, vice chair of the EFCNI executive board6,
  4. Anna L David, professor of obstetrics and maternal fetal medicine2 7
  1. 1Université de Paris, Epidemiology and Statistics Research Center/CRESS, INSERM U1153 EPOPé, INRA, Paris, France
  2. 2Elizabeth Garrett Anderson Institute for Women’s Health London, University College London, London, UK
  3. 3Department of Neonatal Medicine, Maternité Port-Royal, Association Publique des Hôpitaux de Paris (APHP), Paris, France
  4. 4Department of Psychology, University of Warwick, Coventry, UK
  5. 5Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK
  6. 6European Foundation for Care of the Newborn Infant, Munich, Germany
  7. 7National Institute for Health Research, University College London Hospital Biomedical Research Centre, London, UK
  1. Correspondence to AS Morgan andrei.morgan{at}inserm.fr

What you need to know

  • Overall survival of babies born extremely preterm has improved in recent years, but evidence for improvements in longer term neurodevelopmental outcomes is limited

  • Recent changes in obstetric care include how, when, and to whom to administer steroids, surfactant, and new treatments such as antenatal magnesium sulphate or delayed cord clamping and placental transfusion

  • Active participation of parents in treatment may positively influence bonding as well as longer term outcomes for child and family

  • Variability in provision of care for extreme preterm birth has an impact on morbidity and mortality outcomes

  • Extreme preterm birth has a social impact on mothers, fathers, children born preterm, and their families; the value of investing early in life to prevent later complications is now widely recognised

Extreme preterm birth, defined as birth before 28 weeks’ gestational age (box 1),1 affects about two to five in every 1000 pregnancies, and varies slightly by country and by definitions used. Severe maternal morbidity, including sepsis and peripartum haemorrhage, affects around a quarter of mothers delivering at these gestations.2 For the babies, survival and morbidity rates vary, particularly by gestational age at delivery but also according to other risk factors (birth weight and sex, for example) and by country.34 In this update, we focus on high income countries and provide a broad overview of extreme preterm birth epidemiology, recent changes, and best practices in obstetric and neonatal management, including new treatments such as antenatal magnesium sulphate or changes in delivery management such as delayed cord clamping and placental transfusion. We cover short and long term medical, psychological, and experiential consequences for individuals born extremely preterm, their mothers and families, as well as preventive measures that may reduce the incidence of extreme preterm birth.

Box 1

Key definitions

World Health Organization definitions relating to preterm birth

Preterm

  • Birth at less than 37 weeks or 259 days’ gestation

Moderate to late preterm

  • Birth …

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