[What are the current limits for prematurity?].

Abstract

HIGH PREVALENCE: Over the last 15 years, there has been a 2-fold rise in the prevalence of early prematurity (birth before 33 weeks gestation) and very early prematurity (birth between 22 and 28 weeks gestation). More than 7000 infants weighing between 500 g and 1500 g are born alive each year. Survival rates above 50% at 25 weeks, 86% at 29 weeks and 96% at 32 weeks are reported. These infants have the same right to adapted care as any other person. Nevertheless, maternal risks and the fact that these early and very early premature infants account for less than 1% of all births and yet include 50% of all neonatal deaths and 50% of all sequelae. A multidisciplinary approach is crucial for women with a high risk of delivery before 27 weeks gestation. ASSESSING PROGNOSIS: These infants comprise a very heterogeneous group of patients. Their survival and prognosis depends on many different factors. Antenatal factors include gestational age, estimated fetal weight, presence or not of malformations or fetal hypotrophy, and premature rupture of the membranes. During the perinatal period, antenatal corticosteroid therapy, pre-birth referral to a maternity ward with a pediatric intensive care unit, and care and degree of baro-trauma at delivery are essential. The neonatal assessment may lead to discontinuing treatment in case of extensive neurological damage. OPTIMAL CARE: With optimal care, achieved with an organized perinatal network using well-defined criteria for maternal referral, it should be possible to save 650 more children each year and reduce the number of severe handicaps by 390 among infants born before 33 weeks gestation. PREVENTION: Considerable progress has been made in perinatology, but simple and effective preventive measures must not be overlooked: reduction in the number of multiple pregnancies, detection of socio-demographic risk factors, treatment of asymptomatic bacteriuria, early diagnosis of threatening premature birth.