About this Research Topic
The decision to initiate or withhold treatment of mother-infant dyads at 22-24 weeks of gestation remains controversial, with marked differences across hospitals in the obstetrical and neonatal approach at this gestation. Care among infants born at 22-24 weeks of gestation continues to evolve, and we learn from the care we provide for infants born at limits of viability. The relatively small numbers of patients born at 22 weeks of gestation mandate that collaborations are needed to identify best practices for these vulnerable infants.
There are promising developments in the care of mother-infant dyads at 22-24 weeks of gestation, with newer preventive interventions prior to birth, identification of best practices in the delivery room (resuscitation, umbilical cord clamping) and golden hour care. The future challenges include identifying best practices and learning from centers who have optimal outcomes at this vulnerable gestation, with a goal of developing innovative and evidence-based management strategies. Caregivers at risk for delivery at 22-24 weeks of gestation should receive objective, accurate, and up to date information regarding fetal, newborn, and maternal risks and outcomes with delivery or with continued pregnancy. This edition will describe treatment practices across the continuum from fetal life through adolescence among 22-24 week infants, identify gaps in our understanding that warrant additional research, provide a balanced view of the risk/benefit profile regarding treatment at this gestation, and highlight economic and familial implications of our decision to intervene at 22-24 weeks of gestation.
We welcome submissions from the following sub-themes:
• Obstetrical and perinatal care at the limits of viability (magnesium, tocolysis, cord clamping);
• Defining optimal approaches to care: how can we learn from neonatal intensive care units with the best outcomes at 22-24 weeks (Iowa, Sweden, Japan, Germany);
• Investigate why some centers offer or do not offer resuscitation at 22-24 weeks gestation;
• Characterize variability in obstetrical and neonatal care at 22-24 weeks gestation, both within US and across the globe;
• Organ-specific assessment and treatments at 22-24 weeks gestation: PDA care, nutrition, lung development, IVH prevention;
• Collaborative research opportunities to address fundamental gaps in knowledge at 22-24 weeks gestation, with consideration of ethical and economic implications of our care.
This Research Topic has received financial support from Nationwide Children's Hospital, United States.
Keywords: limits of viability, preterm birth, periviability, extreme prematurity, neonate
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