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Effect of national guidance on survival for babies born at 22 weeks’ gestation in England and Wales: population based cohort study

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journal contribution
posted on 2023-12-15, 14:33 authored by Lucy Smith, Emily van Blankenstein, Grenville Fox, Sarah Seaton, Mario Martínez-Jiménez, Stavros Petrou, Cheryl Battersby

Objectives To explore the effect of changes in national clinical recommendations in 2019 that extended provision of survival focused care to babies born at 22 weeks’ gestation in England and Wales.


Design Population based cohort study.


Setting England and Wales, comprising routine data for births and hospital records.


Participants Babies alive at the onset of care in labour at 22 weeks+0 days to 22 weeks+6 days and at 23 weeks+0 days to 24 weeks+6 days for comparison purposes between 1 January 2018 and 31 December 2021.


Main outcome measures Percentage of babies given survival focused care (active respiratory support after birth), admitted to neonatal care, and surviving to discharge in 2018-19 and 2020-21.


Results For the 1001 babies alive at the onset of labour at 22 weeks' gestation, a threefold increase was noted in: survival focused care provision from 11.3% to 38.4% (risk ratio 3.41 (95% confidence interval 2.61 to 4.45)); admissions to neonatal units from 7.4% to 28.1% (3.77 (2.70 to 5.27)), and survival to discharge from neonatal care from 2.5% to 8.2% (3.29 (1.78 to 6.09)). More babies of lower birth weight and early gestational age received survival focused care in 2020-21 than 2018-19 (46% to 64% at <500g weight; 19% to 31% at 22 weeks+0 days to 22 weeks+3 days).


Conclusions A change in national guidance to recommend a risk based approach was associated with a threefold increase in 22 weeks’ gestation babies receiving survival focused care. The number of babies being admitted to neonatal units and those surviving to discharge increased.

Funding

Optimising care for parents experiencing mid-trimester pregnancy loss by reducing variation in policy and practice

NIHR Academy

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WONDER: A Whole Population Data linkage approach to improving long-term health and wellbeing of preterm babies

NIHR Academy

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Understanding the epidemiology, experiences and variation in the transition from neonatal to paediatric care: a mixed methods study

National Institute for Health Research

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PhD studentship from the Joint Research Committee of Chelsea and Westminster Hospital and the Westminster Medical School Research Trust (refJRC PHD 001 2022-23)

UK National Institute for Health Research (NIHR) Senior Investigator (NF-SI-0616-10103

UK NIHR Applied Research Collaboration Oxford and Thames Valley

History

Author affiliation

Department of Population Health Sciences, University of Leicester

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  • VoR (Version of Record)

Published in

BMJ Medicine

Volume

2

Publisher

BMJ

issn

2754-0413

Copyright date

2023

Available date

2023-12-15

Language

en

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