Infant wellbeing at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentred randomised controlled trial.
Background: Although delivery is widely used for preterm babies failing to thrive in utero, the effect of altering delivery timing has never been assessed in a randomised controlled trial. We aimed to compare the effect of delivering early with delaying birth for as long as possible.Methods: 548 pre...
| Publicado en: | Lancet Vol. 364; no. 9433; pp. 513 - 521 |
|---|---|
| Autores principales: | , , , , |
| Formato: | research tables/charts randomized controlled trial Journal Article |
| Publicado: |
Lancet
8/7/2004
|
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106583594&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106583594 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01406736 LAN jtl: Lancet issn: 01406736 maglogo: N pubinfo: dt: 8/7/2004 vid: 364 iid: 9433 pid: 1297 pub: Lancet place: Philadelphia, Pennsylvania artinfo: ui: 106583594 106583594 NLM15302194 2005039361 10.1016/s0140-6736(04)16809-8 NLM15302194 106583594 ppf: 513 ppct: 8 formats: fmt: @attributes: type: P tig: atl: Infant wellbeing at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentred randomised controlled trial. aug: au: Thornton, J G Hornbuckle, J Vail, A Spiegelhalter, D J Levene, M sug: subj: Delivery, Obstetric Fetal Growth Retardation Gestational Age Child, Preschool Clinical Assessment Tools Randomized Controlled Trials Confidence Intervals Developmental Disabilities Diagnosis, Developmental Female Fetal Development Fetus Infant Development Infant, Newborn Logistic Regression Odds Ratio Perinatal Death Pregnancy Pregnancy Outcomes Pregnancy, High Risk Prospective Studies Random Assignment Scales Human Child, Preschool: 2-5 years Fetus, conception to birth Infant, Newborn: birth-1 month Female ab: Background: Although delivery is widely used for preterm babies failing to thrive in utero, the effect of altering delivery timing has never been assessed in a randomised controlled trial. We aimed to compare the effect of delivering early with delaying birth for as long as possible.Methods: 548 pregnant women were recruited by 69 hospitals in 13 European countries. Participants had fetal compromise between 24 and 36 weeks, an umbilical-artery doppler waveform recorded, and clinical uncertainty about whether immediate delivery was indicated. Before birth, 588 babies were randomly assigned to immediate delivery (n=296) or delayed delivery until the obstetrician was no longer uncertain (n=292). The main outcome was death or disability at or beyond 2 years of age. Disability was defined as a Griffiths developmental quotient of 70 or less or the presence of motor or perceptual severe disability. Analysis was by intention-to-treat. This trial has been assigned the International Standard Randomised Controlled Trial Number ISRCTN41358726.Findings: Primary outcomes were available on 290 (98%) immediate and 283 (97%) deferred deliveries. Overall rate of death or severe disability at 2 years was 55 (19%) of 290 immediate births, and 44 (16%) of 283 delayed births. With adjustment for gestational age and umbilical-artery doppler category, the odds ratio (95% CrI) was 1.1 (0.7-1.8). Most of the observed difference was in disability in babies younger than 31 weeks of gestation at randomisation: 14 (13%) immediate versus five (5%) delayed deliveries. No important differences in the median Griffiths developmental quotient in survivors was seen.Interpretation: The lack of difference in mortality suggests that obstetricians are delivering sick preterm babies at about the correct moment to minimise mortality. However, they could be delivering too early to minimise brain damage. These results do not lend support to the idea that obstetricians can deliver before terminal hypoxaemia to improve brain development. pubtype: Academic Journal doctype: research tables/charts randomized controlled trial Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
|---|