Clinical Trial Summary
Advancements in perinatal care have significantly improved the survival of extremely
premature infants, establishing a viability threshold below 25 weeks' gestational age (GA).
However, management at the limit of viability poses ethical and decision-making problems for
health-care professionals. They grapple with the delicate balance between potential survival
and long-term disabilities.
These decisions, as well as the information given to families, are based on knowledge of the
prognosis as assessed by national and international epidemiological studies. Healthcare
professionals rely on population-based estimations but face discrepancies in predicting
outcomes because there are significant variation depending on perinatal center and country
where infants are hospitalized. In the large French epidemiological study, 9,6% of livebirths
included were born at 22-25 wks and only 38% survived.
In the neonatology department of the croix rousse, these infants have been actively cared for
for many years, which has allowed the development of specific skills that are essential for
the proper management of these very high-risk patients. Furthermore, EPIPAGE 2 included data
from centers where perinatal management was probably not very active at these extreme ages.
It results in worse neonatal outcomes as evaluated at the national level than outcomes data
evaluated at the neonatal intensive care unit of Croix-Rousse hospital. Using data from
EPIPAGE 2 study for clinical decision could lead to avoid active care at the for some infants
at the limit of viability It is needed to obtain complete evaluation of neonatal outcomes of
infants hospitalized at the Croix-Rousse hospital, so that clinicians may rely on actualized
data related to the practices in their perinatal center. It is also needed to compare
outcomes with data from large national and international cohorts, to identify and quantify
differences. Data about later neurodevelopment outcomes, at 2 years, are also needed as it
can taken in consideration in decision-making process.