Timing preemie deliveries to minimize brain damage

While obstetricians seem to be delivering sick preterm babies at about the right time to minimize death, they still may be delivering them too early to minimize brain damage, according to the multicenter, randomized Growth Restriction Intervention Trial (GRIT).

To reach that conclusion more than 500 pregnant women with fetal compromise between 24 and 36 weeks' gestation were recruited by 69 hospitals in 13 European countries. Before birth, 296 women were randomly assigned to immediate delivery to preempt intrauterine hypoxia while 292 waited to deliver until their obstetrician felt that delivery could wait no longer (up to 4 days later) in order to gain fetal maturity.

The researchers noted little difference between the groups, with 19% of the immediate delivery group dying or becoming severely disabled at 2 years versus 16% of the delayed delivery group. Most of the difference occurred in babies born younger than 31 weeks. At 2 years of age, the researchers noted a trend towards more disability in the immediate delivery group, but no overall difference in Griffiths developmental quotient in survivors.

The researchers concluded that obstetricians should delay delivering fetuses-particularly those 30 weeks' gestation and younger-as long as possible.

Thorton JG, Hornbuckle J, Vail A, et al. Infant wellbeing at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentred randomised controlled trial. Lancet. 2004;364:513-520.