Thesis supervisor: Péter Varga
Location of studies (in Hungarian): SE Abbreviation of location of studies: SE
Description of the research topic:
The definitions of the limit of viability is based on the ability of the fetus to survive outside the uterus when supported by the most advanced medical care [1]. This definition does not consider the chances of survival or the individual’s quality of life. Therefore, it is essential to know the other limit at which a preterm infant has a significant chance to survive without severe neurological impairment.
The threshold of viability lies between these 2 boundaries. The care of neonates born within this gray zone represents a major moral and ethical dilemma for perinatal health care providers [2].
Prognosis of preterm infants born at the threshold of viability is highly influenced by several confounding factor, mainly gestational age and birth weight. Female gender is a favourable, multiple pregnancies is an unfavourable prognostic factor [3]. Antenatal steroid therapy improves preterm infant survival and reduces the incidence of respiratory distress syndrome, intraventricular haemorrhage and necrotising enterocolitis [4]. Preterm infants born in a regional center have a better chance for survival [5]. The beneficial effect of caesarean section is still debated [6, 7]. There has been only a few study published about the topic, from the Eastern Central European region [8].
Target group, specimens:
Subjects of the study: Preterm infants born before the 27th gestational week, in Hungary. There are approximately 150 periviable infants born each year in Hungary.
Data: Data collection from the Hungarian PIC database, medical files of preterm infants born at the Semmelweis University.
Specimen: Placenta and umbilical cord samples, blood samples, microbiological samples
Aims:
- To investigate the outcomes of infants born at the threshold of viability in Hungary
- To investigate the role of perinatal factors in the prognosis of infants born at the threshold of viability
Methods:
Statistical analysis of the collected data from the Hungarian PIC database. Evaluation of clinical and laboratory findings of preterm infants born at the Semmelweis University.
Budapest, August 30. 2022 Peter Varga MD PhD
References:
1. Richard J Martin, A.A.F., Michele C Walsh, Fanaroff and Martin’s neonatal-perinatal medicine: diseases of the fetus and infant. 2011, Philadelphia: Elsevier/Saunder.
2. Fanczal, E., et al., The Prognosis of Preterm Infants Born at the Threshold of Viability: Fog Over the Gray Zone - Population-Based Studies of Extremely Preterm Infants. Med Sci Monit, 2020. 26: p. e926947.
3. Tyson, J.E., et al., Intensive care for extreme prematurity--moving beyond gestational age. N Engl J Med, 2008. 358(16): p. 1672-81.
4. Ehret, D.E.Y., et al., Association of Antenatal Steroid Exposure With Survival Among Infants Receiving Postnatal Life Support at 22 to 25 Weeks’ Gestation. JAMA Network Open, 2018. 1(6): p. e183235-e183235.
5. Anderson, J.G., et al., Survival and Major Morbidity of Extremely Preterm Infants: A Population-Based Study. Pediatrics, 2016. 138(1).
6. Alfirevic, Z., S.J. Milan, and S. Livio, Caesarean section versus vaginal delivery for preterm birth in singletons. Cochrane Database of Systematic Reviews, 2012(6).
7. Zahedi-Spung, L.D., et al., Neonatal morbidity and mortality by mode of delivery in very preterm neonates. Am J Obstet Gynecol, 2022. 226(1): p. 114.e1-114.e7.
8. Varga, P., et al., Survival and early complications of preterm infants with birthweight less than 500 grams during a 10-year period in Hungary. Paediatric and Perinatal Epidemiology, 2020. 34(5): p. 565-571
Number of students who can be accepted: 3
Deadline for application: 2024-05-31
2024. IV. 17. ODT ülés Az ODT következő ülésére 2024. június 14-én, pénteken 10.00 órakor kerül sor a Semmelweis Egyetem Szenátusi termében (Bp. Üllői út 26. I. emelet).
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