Strategies to Overcome the Limit of Viability of Microprimie

Chang, Yun Sil; Park, Won Soon

Abstract

Recently, the survival rate of microprimies born on the verge of viability has increased with the development of perinatal medicine and neonatal intensive care. The treatment policies for microprimies vary at each center and in different countries. The main concerns in such infants are their poor survival, morbidity, and long-term prognosis as well as the increasing burden associated with the medical and social resources necessary to support them. However, the aggressive treatment of microprimies has improved the prognosis of more mature preterm infants. Practical strategies to overcome the limit of viability of microprimies include active prenatal and neonatal intensive care such as antenatal steroid administration and aggressive and gentle resuscitation policies; meticulous temperature, fluid, and respiratory therapy; and permissive control of hypotension and hyperglycemia through the application of minimal and non-invasive treatment modalities from an early age. Aggressive early enteral and parenteral nutrition with strict sepsis prevention is also important. The establishment of policies and feedback systems in each individual center, including patient-family oriented care, is an effective method for quality improvement. However, many of the surviving microprimies develop severe diseases such as bronchopulmonary dysplasia and high-grade intraventricular hemorrhage. New therapeutic modalities such as stem cell therapy need to be developed to overcome these intractable diseases.