Book contents
- Frontmatter
- Contents
- Part 1 THE EXTREMELY PRETERM INFANT: EPIDEMIOLOGY, PERCEPTIONS, AND PRACTICES
- 1 Introduction
- 2 Historical Aspects
- 3 Survival
- 4 Influence of Obstetric Management
- 5 Effect of Resuscitation in the Delivery Room
- 6 National Comparisons
- 7 Prediction of Outcome
- 8 Limit of Viability
- 9 Morbidity
- 10 School Age Outcome
- 11 Adolescence
- 12 Perceptions and Practices
- 13 Resource Expenditure
- Part 2 BIOETHICS
- Part 3 REPORTS, OFFICIAL OPINIONS, AND GUIDELINES
- Part 4 THE LAW
- Part 5 EPILOGUE: TRUTH, TRUST, AND BOUNDARIES
- References
- Index
3 - Survival
Published online by Cambridge University Press: 23 September 2009
- Frontmatter
- Contents
- Part 1 THE EXTREMELY PRETERM INFANT: EPIDEMIOLOGY, PERCEPTIONS, AND PRACTICES
- 1 Introduction
- 2 Historical Aspects
- 3 Survival
- 4 Influence of Obstetric Management
- 5 Effect of Resuscitation in the Delivery Room
- 6 National Comparisons
- 7 Prediction of Outcome
- 8 Limit of Viability
- 9 Morbidity
- 10 School Age Outcome
- 11 Adolescence
- 12 Perceptions and Practices
- 13 Resource Expenditure
- Part 2 BIOETHICS
- Part 3 REPORTS, OFFICIAL OPINIONS, AND GUIDELINES
- Part 4 THE LAW
- Part 5 EPILOGUE: TRUTH, TRUST, AND BOUNDARIES
- References
- Index
Summary
From 1980 to 2000, the infant mortality rate in the United States has been reduced from 12.6 to 6.9 per 1,000 live births.(9, 10) This has occurred with an approximately 17% increase in preterm birth rates,(9, 11) and reductions in mortality have been highest for those with the lowest birth weights.(9) This has been mainly attributable to gains in technology as well as improvements in medical practice.(12–15) ELBW infants account for nearly half of total perinatal mortality, despite being only a very small percentage of total live births.(16) Much of the improvement in mortality has occurred in the very and extremely preterm groups.(17, 18) There can be considerable variation in the results of studies reporting mortality for the EPTI. To some extent this is governed by the conduct of the studies,(19, 20) for example, whether the figures reported include total births, live births, or neonatal intensive care unit (NICU) admissions; whether the numbers were small or based on geographic populations; and whether there were consistent approaches to management. Clearly this variability may introduce uncertainty and incomprehensibility into the counseling of parents. Furthermore, one can speculate whether it might encourage a paternalistic use of figures by physicians, when counseling, allowing for a reflection of their biases. One physician might aggressively resuscitate, whereas another might not.(21, 22) But most well-conducted studies quote similar figures, or if there is variability, explanations can be found. More recent improvements in survival are particularly notable for those born at less than 26 weeks' gestation.
- Type
- Chapter
- Information
- Extreme PrematurityPractices, Bioethics and the Law, pp. 11 - 15Publisher: Cambridge University PressPrint publication year: 2006