3P-S5-1

ADVANCES IN NEONATAL INTENSIVE CARE FOR EXTREMELY PREMATURE INFANTS

Yu Victor

Monash University, Melbourne, Australia

A combined perinatal-neonatal approach by obstetricians-neonatologists, and the use of antenatal betamethasone and postnatal surfactant, are the greatest advances in the care of extremely premature infants in the last two decades. We are able to monitor continuously and noninvasively their oxygen and carbon dioxide. Treatment options include high frequency oscillatory ventilation for respiratory failure, inhaled nitric oxide for persistent pulmonary hypertension, and indomethacin for patent ductus arteriosus. The most effective prevention for necrotising enterocolitis is expressed breast milk. Nutritional intake is enhanced by fortifiers added to human milk and by supplemental parenteral nutrition. Specialised preterm formulas are available if required. Population-based studies of all births within a geographical-defined region have revealed the importance of their place of birth. Not only were stillbirth and neonatal death rates of extremely premature infants lower in those born within major perinatal centres compared with those born elsewhere, their severe disability rate was also lower. Poor parental education and low occupational and socioeconomic status were associated with worse cognitive function. Our population-based study has shown that survival rates have improved dramatically (41% at 23 weeks, 45% at 24 weeks, 73% at 25 weeks) while the severe disability rate has remained low. Although surfactant and mechanical ventilation are expensive therapies, the resulting improvement in outcome has resulted in an increase in cost effectiveness. Neonatal intensive care for extremely premature infants is more cost effective than transplantation programs, renal dialysis, coronary bypass surgery and coronary care. To reduce the neurodisability rate further, research is being conducted into the pathophysiology of neonatal brain injury in extremely premature infants, and a number of promising strategies are already being studied using randomised controlled clinical trials.