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Delaying Birth of Premature Infants May Prevent Brain Damage, Disabilities, Study Says

Kaisernetwork.org Daily Reproductive Health Report
August 9, 2004

Delaying the birth of premature infants for as long as possible may prevent brain damage and disabilities, according to a study published in the Aug. 7 issue of the Lancet, Reuters reports (Reaney, Reuters, 8/5). Jim Thornton of the Division of Obstetrics and Gynecology at Nottingham City Hospital in England studied 548 pregnant women in 13 European countries who were identified as having complications with their pregnancies at between 24 and 36 weeks gestation. Researchers randomly assigned 296 of the 588 fetuses to be delivered immediately and delayed delivery as long as possible for the remaining 292 fetuses (Thornton et al., Lancet, 8/7). Some obstetricians believe that it is best for a fetus that is not thriving to be delivered immediately even if it has not yet reached 40 weeks gestation, according to Reuters. Although premature infants have higher risks of experiencing respiratory problems, cerebral palsy and other disabilities, infants can be stillborn if delivery is delayed too long, according to Reuters (Reuters, 8/5).

Findings
Among the infants studied, the rate of death or severe disability after age two among those delivered immediately was 19%, compared with 16% among those whose births were delayed for an average of 4.5 days, according to the study (Lancet, 8/7). In addition, although there was no difference in the death rate among the groups, the researchers found that the disability rate in the immediate delivery group was 8%, compared with 4% in the delayed delivery group. However, the most significant difference in disability rates was among infants born at fewer than 31 weeks gestation (Reuters, 8/5). The disability rate in these infants was 13% for immediate deliveries and 5% for delayed births (Lancet, 8/7). "A lot of babies are delivered prematurely because the obstetrician says it would be safer out (of the womb) than in," Thornton said, adding, "Hopefully our results will give doctors better information to make those crucial decisions" (Reuters, 8/5). The findings suggest that obstetricians are delivering premature infants "at about the correct moment to minimize mortality" but could be "delivering too early to minimize brain damage," the researchers concluded (Lancet, 8/7).

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