INVITRO FERTILIZATION - A NEONATAL PEDIATRICIANS PERSPECTIVE

EDITORIAL COMMENT: This thoughtful essay has no summary; we provide this comment to make sure readers do not miss the ‘conclusion’ or the important audit of the clinical results achieved at the Royal Women's Hospital Intensive Care nursery, 1986–1988. Neonatal paediatricians are not the only ones who question modern obstetric practice — there is often debate at stillbirth and neonatal death committees of the Consultative Council on Obstetric and Paediatric Mortality and Morbidity attended by the editor as to the wisdom of many Caesarean sections performed at or before 26 weeks' gestation because of severe preeclampsia or severe fetal compromise — unfortunately many of these women require a classical Caesarean section because the lower segment is poorly developed. Of course there is no good news at mortality meetings and one must turn to the data from the perinatal units to see the overall survival rates for early deliveries. In Victoria in 1987, the perinatal mortality rate for infants with birth‐weight 500 g or above was 11.0 per 1,000 births (677 of 61,090), the neonatal death rate being 4.7per 1,000. However, the perinatal mortality rate was 738 per 1,000 births in the group of 294 infants with birth‐weight 500–999 g. In 1987 there were 46 deliveries by Caesarean section before 28 weeks' gestation and the results were 5 stillbirths, 14 neonatal deaths and 27 survivors. Results of intensive care of extremely low birth‐weight infants would suggest that the current Caesarean section rate in high risk pregnancies before 28 weeks' gestation should not be extended. One has only to read our newspapers to learn the problems of provision of resources for intensive care — individual parents and their paediatrician may press for increased availability of the new technology for any liveborn infant but there is a limit to what the State can afford — it could be argued that the neonatal intensive care facilities currently available in Australia are adequate. Copyright © 1990, Wiley Blackwell. All rights reserved