Lee12 calculated that

Lee12 calculated that infants born at 22–25 weeks and who are in the highest-risk category (male gender, no antenatal steroids, multiple birth, and lower weight percentile) #click here randurls[1|1|,|CHEM1|]# have a mortality rate of over 80%, while for the lower-risk infants it is less than 20%. Given all the above data, what is one to do when confronted with an impending delivery at the limits of viability, i.e. 22–24 weeks? Whose data should serve as the reference point

for discussions with the parents? Whose Inhibitors,research,lifescience,medical data are so biased by a self-fulfilling prophesy of poor survival that they reflect an arbitrary decision not to initiate intensive care in infants born earlier than a given gestational age? Whose data have not factored in weight, gender, or administration of antenatal steroids Inhibitors,research,lifescience,medical in the decision-making process?4,13 In fact, careful perusal of the published reports does not allow one to conclude that we have

reached the biologic end of the line and that there is no more room for further improvement in the survival rate of these extremely immature infants, as in essence we have become prisoners of our own expectations. LONG-TERM MORBIDITY OUTCOME To many, the decision-making in this moral gray zone has been primarily influenced by the published Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical data as to the long-term neurodevelopmental outcome of the surviving infants and not mortality rates. Reports on follow-up data from the NICHD Network14 from two treatment epochs (E1: 1999–2001 and E2: 2002–2004) have noted that there was no improvement in early childhood outcome between the two periods (mirroring Inhibitors,research,lifescience,medical the lack of improvement in survival rates). In both periods

there was comparable use of prenatal steroids (approximately 80%), and there was no significant difference in the percentage of multiple births or female infants. The rate of significant neurodevelopmental impairment at 18–22 months in surviving infants born at 23 weeks or less was similar in both epochs, 23.6% in E1 and 26.5% in E2, and at 24 weeks it was 14.6% in E1 and 14.2% in E2. Most importantly, the percentage of the surviving infants born at 24 weeks or less who were unimpaired or only minimally impaired was no through different in both epochs and was only 22%. As such, these data highlighting such a poor outcome have served for many as the basis for the global recommendation of restrictive care for the infant born before 24 weeks of gestation, i.e. limiting care to non-treatment and comfort care only. Unfortunately, the fact that such recommendations are unrelated to the various factors that significantly modify survival rates speaks of poor ethical reasoning.

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