Narrative review of perinatal management of extremely preterm infants: what’s the evidence?

Abstract

Background and Objective: Although significant advances have been made in perinatal medicine during the past few decades, the care of extremely preterm infants remains a great challenge to families, physicians, and the entire health care system. Due to extreme prematurity, extremely preterm infants are at increased risk of mortality and morbidity. The aim of this narrative review is to discuss the perinatal management strategies that may improve the short- and long-term outcomes of these vulnerable infants. Key Content and Findings: Advances in perinatal care have resulted in increased survival for extremely preterm infants, but these vulnerable infants remain at high risk of mortality and morbidity. Numerous proactive management strategies need to be implemented during perinatal period so that the mortality and impairment rates of extremely preterm infants can be minimized. Some management strategies have been proven beneficial by large meta-analyses or randomized controlled trials. However, the efficacy and safety of some other strategies, especially some emerging strategies, are still unclear. Conclusions: Many perinatal management strategies have shown to be related to improving outcomes in extremely preterm infants. And a lot of novel strategies are under investigation and some already have promising early results. However, the answers of some important questions in the care of EPIs remain unsatisfying. And the long-term effects of some perinatal strategies are still unclear. Further large-sample, well-designed randomized controlled trials are needed to confirm their safety and efficacy.