Neonatal stabilisation should now be considered for babies born from 22 weeks of gestation following assessment of risk and multi-professional discussion with parents, according to new guidance from the British Association of Perinatal Medicine (BAPM).
The framework for practice for Management of Extreme Preterm Birth Before 27 weeks of Gestation (2019) presents UK and international evidence and recommends a risk-based approach (graded from extremely high risk to moderate) to clinical decision-making for babies born between 22 and 27 weeks of gestation.
The previous BAPM advice was that for foetuses/babies less than 23 years, resuscitation should not to be carried out. However, the BAPM points out that when the document was published in 2008, only two out of 10 babies born at 23 weeks and receiving treatment in neonatal intensive care units would survive. Since then, advances in neonatal and obstetric care have improved survival rates for the most premature babies and today, four out of 10 babies born at 23 weeks and receiving treatment in UK neonatal units are expected to survive.
The new guidance advises that risk assessment should be performed with the aim of stratifying the risk of a poor outcome into three groups: extremely high risk, high risk and moderate risk.
For foetuses/babies at extremely high risk, palliative care would be the usual management. For those at high risk of poor outcome, the decision to provide either active management or palliative care should be based primarily on the wishes of the parents. For foetuses/babies at moderate risk, active management should be planned, the framework recommends.
Dr Helen Mactier, President of the BAPM and consultant neonatologist at the Princess Royal Maternity in Glasgow, says the updated guidance “aligns recommended clinical practice with the most up-to-date science, ensuring that advice to parents is consultative, consistent and evidence-based.”