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

Objective: To review the current evidence for management strategies applied during perinatal period to improve the short- and long- term outcomes in extremely preterm infants (EPIs). Background: EPIs are defined as infants born before 28 completed weeks of gestation. Due to extreme prematurity, a large number of EPIs are at increased risk for both mortality and morbidity. Although significant advances have been made in neonatal and perinatal medicine, the management of EPIs remains a great challenge to families, physicians, and the entire health care system. Methods: Literature searches were conducted in PubMed, Cochrane Library, OVID, Embase, and Web of Science to identify studies regarding perinatal management of EPIs from 2000 to 2021. Observational studies, randomized controlled trials (RCTs), systematic reviews and meta-analyses were included. The title and abstract of each article were screened for the selection of relevant articles. Conclusions: Numerous proactive interventions need to be implemented during this critical perinatal period so that the mortality and impairment rates of these vulnerable infants can be minimized. The effectiveness and safety of some interventions have been widely studied in large meta-analyses or RCTs. Meanwhile, a lot of novel management strategies are under investigation and many already have promising early results. However, the long-term effects of some intervention efforts remain limited. The answers of some important questions in the care practice of EPIs remain unsatisfying. 21