{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T03:51:03Z","timestamp":1773546663979,"version":"3.50.1"},"reference-count":57,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,8,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND AND OBJECTIVES:<\/jats:title>\n                  <jats:p>Available data on survival rates and outcomes of extremely low gestational age (GA) infants (22\u201325 weeks\u2019 gestation) display wide variation by country. Whether similar variation is found in statements by national professional bodies is unknown. The objectives were to perform a systematic review of management from scientific and professional organizations for delivery room care of extremely low GA infants.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>We searched Embase, PubMed, and Google Scholar for management guidelines on perinatal care. Countries were included if rated by the United Nations Development Programme\u2019s Human Development Index as \u201cvery highly developed.\u201d The primary outcome was rating of recommendations from \u201ccomfort care\u201d to \u201cactive care.\u201d Secondary outcomes were specifying country-specific survival and considering potential for 3 biases: limitations of GA assessment; bias from different definitions of stillbirths and live births; and bias from the use of different denominators to calculate survival.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>Of 47 highly developed countries, 34 guidelines from 23 countries and 4 international groups were identified. Of these, 3 did not state management recommendations. Of the remaining 31 guidelines, 21 (68%) supported comfort care at 22 weeks\u2019 gestation, and 20 (65%) supported active care at 25 weeks\u2019 gestation. Between 23 and 24 weeks\u2019 gestation, much greater variation was seen. Seventeen guidelines cited national survival rates. Few guidelines discussed potential biases: limitations in GA (n = 17); definition bias (n = 3); and denominator bias (n = 7).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>Although there is a wide variation in recommendations (especially between 23 and 24 weeks\u2019 GA), there is general agreement for comfort care at 22 weeks\u2019 GA and active care at 25 weeks\u2019 GA.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/peds.2015-0542","type":"journal-article","created":{"date-parts":[[2015,7,14]],"date-time":"2015-07-14T00:49:28Z","timestamp":1436834968000},"page":"343-350","source":"Crossref","is-referenced-by-count":182,"title":["Guidelines for the Management of Extremely Premature Deliveries: A Systematic Review"],"prefix":"10.1542","volume":"136","author":[{"given":"\u00darsula","family":"Guill\u00e9n","sequence":"first","affiliation":[{"name":"Division of Neonatology, Christiana Care Health System, Newark, Delaware;"}]},{"given":"Elliott M.","family":"Weiss","sequence":"additional","affiliation":[{"name":"Division of Neonatology, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania;"}]},{"given":"David","family":"Munson","sequence":"additional","affiliation":[{"name":"Division of Neonatology, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania;"}]},{"given":"Pierre","family":"Maton","sequence":"additional","affiliation":[{"name":"CHC St Vincent, Rocourt, Belgium;"}]},{"given":"Ann","family":"Jefferies","sequence":"additional","affiliation":[{"name":"Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada;"}]},{"given":"Mikael","family":"Norman","sequence":"additional","affiliation":[{"name":"Department of Neonatal Medicine, Karolinska Hospital, Stockholm, Sweden;"}]},{"given":"Gunnar","family":"Naulaers","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium;"}]},{"given":"Joana","family":"Mendes","sequence":"additional","affiliation":[{"name":"Sao Francisco Xavier Hospital, Lisbon, Portugal;"}]},{"given":"Lincoln","family":"Justo da Silva","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Lisbon Medical School, Lisbon, Portugal;"}]},{"given":"Petr","family":"Zoban","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Charles University, Prague, Czech Republic;"}]},{"given":"Thor W.R.","family":"Hansen","sequence":"additional","affiliation":[{"name":"Women & Children's Division, Oslo University Hospital, Oslo, Norway;"},{"name":"Faculty of Medicine, University of Oslo, Oslo, Norway;"}]},{"given":"Mikko","family":"Hallman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Oulu University Hospital and University of Oulu, Oulu, Finland;"}]},{"given":"Maria","family":"Delivoria-Papadopoulos","sequence":"additional","affiliation":[{"name":"Division of Neonatology, St Christopher\u2019s Hospital for Children, Philadelphia, Pennsylvania;"}]},{"given":"Shigeharu","family":"Hosono","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan;"}]},{"given":"Susan G.","family":"Albersheim","sequence":"additional","affiliation":[{"name":"Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada;"}]},{"given":"Constance","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada;"}]},{"given":"Elaine","family":"Boyle","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Leicester, Leicester, United Kingdom;"}]},{"given":"Kei","family":"Lui","sequence":"additional","affiliation":[{"name":"Department of Newborn Care, University of New South Wales, Sydney, Australia; and"}]},{"given":"Brian","family":"Darlow","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Otago, Christchurch, New Zealand"}]},{"given":"Haresh","family":"Kirpalani","sequence":"additional","affiliation":[{"name":"Division of Neonatology, The Children\u2019s Hospital of Philadelphia, Philadelphia, Pennsylvania;"}]}],"member":"417","published-online":{"date-parts":[[2015,8,1]]},"reference":[{"key":"2021120906094031400_B1","first-page":"w13280","article-title":"Perinatal care at the limit of viability between 22 and 26 completed weeks of gestation in Switzerland. 2011 revision of the Swiss recommendations.","volume":"141","author":"Berger","year":"2011","journal-title":"Swiss Med Wkly"},{"issue":"2","key":"2021120906094031400_B2","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1542\/peds.2008-0763","article-title":"Mortality rates for extremely low birth weight infants born in Japan in 2005.","volume":"123","author":"Itabashi","year":"2009","journal-title":"Pediatrics"},{"key":"2021120906094031400_B3"},{"key":"2021120906094031400_B4"},{"issue":"4","key":"2021120906094031400_B5","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1055\/s-0030-1268714","article-title":"One hundred consecutive infants born at 23 weeks and resuscitated.","volume":"28","author":"Batton","year":"2011","journal-title":"Am J Perinatol"},{"issue":"3","key":"2021120906094031400_B6","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1046\/j.1365-3016.2001.00355.x","article-title":"The reliability of perinatal and neonatal mortality rates: differential under-reporting in linked professional registers vs. Dutch civil registers.","volume":"15","author":"Anthony","year":"2001","journal-title":"Paediatr Perinat Epidemiol"},{"key":"2021120906094031400_B7"},{"issue":"3","key":"2021120906094031400_B8","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1016\/j.jpeds.2011.08.070","article-title":"Development and pretesting of a decision-aid to use when counseling parents facing imminent extreme premature delivery.","volume":"160","author":"Guill\u00e9n","year":"2012","journal-title":"J Pediatr"},{"key":"2021120906094031400_B9"},{"issue":"2","key":"2021120906094031400_B10","first-page":"189","article-title":"Predicting delivery date by ultrasound and last menstrual period in early gestation.","volume":"97","author":"Taipale","year":"2001","journal-title":"Obstet Gynecol"},{"issue":"3","key":"2021120906094031400_B11","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/j.ajog.2004.06.053","article-title":"First- and second-trimester ultrasound assessment of gestational age.","volume":"191","author":"Kalish","year":"2004","journal-title":"Am J Obstet Gynecol"},{"key":"2021120906094031400_B12","doi-asserted-by":"crossref","first-page":"e746","DOI":"10.1136\/bmj.e746","article-title":"Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population based retrospective study.","volume":"344","author":"Joseph","year":"2012","journal-title":"BMJ"},{"key":"2021120906094031400_B13"},{"issue":"1","key":"2021120906094031400_B14","first-page":"70","article-title":"Recommendations in Neonatal Resuscitation 2011: 3rd part: medication and volume expanders. 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