UAB Synopsis, Vol. 27, No. 22, June 9, 2008

It’s About More Than Gestational Age, UAB and NIH Network Find

A study involving UAB Hospital’s Regional Newborn Intensive Care Unit (RNICU) and the NIH Neonatal Research Network provides guidelines that give physicians and parents more information on which to base decisions about how aggressively to treat extremely low birthweight babies — generally those born between 22 and 25 weeks gestational age.

Babies in the UAB Hospital RNICU were among those involved in the trial, which was published April 17 in The New England Journal of Medicine. Researchers observed nearly 4450 babies with gestational age from 22 to 25 weeks weighing less than 1000 grams.

UAB principal investigator Waldemar A. Carlo, MD, professor and director of the Division of Neonatology, says, “Traditionally physicians relied to a great extent on gestational age in predicting survival and disability risk. Gestational age is not always precise, and we wanted to know other factors that play roles so we can help new parents make decisions regarding the care of their premature infant.”

The study found that an infant’s chances for survival and growing up without a disability are increased when the mother is given corticosteroids, which mature fetal lungs, and if the baby is female, a singleton, of a higher birth weight, and of a greater gestational age.

Parents and physicians can access the study findings at a Web site created by the National Institute of Child Health and Human Development (NICHD), sponsor of the research network of neonatal units. The site includes an Internet-based tool http://www.nichd.nih.gov/about/org/cdbpm/pp/prog_epbo/ that allows factors for any extremely low birthweight baby to be entered into an algorithm that calculates a baby’s probability of healthy survival.

“The study was done to get the best information we have to share with parents to give hope where hope is due, but also to be realistic when there isn’t much chance of hope,” says UAB neonatologist Robert L. Schelonka, MD, associate professor of pediatrics.

The new guidelines will not be the sole determinant a baby’s fate. “That will still depend on discussions we have with families about their preferences in managing treatment of their newborn,” he says.

Dr. Carlo points out that UAB’s survival rate for all premature babies significantly exceeds the national average, as does its rate for survival without apparent mental, auditory, and visual disabilities.

UAB is one of the original eight NICHD research sites commissioned in 1986 and is the only facility in the country involved in all three of the NIH research initiatives for maternal, child, and family health: the Neonatal Research Network, the Maternal-Fetal Medicine Units Network, and the Global Network for Women’s and Children’s Health Research.

Coinvestigators for the UAB arm of the study included Ada Myriam Peralta-Carcelen, MD, and nurse coordinators Monica Vogt Collins, BSN, MaEd; Shirley S. Cosby; and Vivian A. Phillips.