From the Guidelines
For a fetus at 23 weeks of gestation, the decision to proceed with resuscitation should be considered on a case-by-case basis, taking into account individual circumstances, including specific clinical issues, family values and wishes, and ongoing evaluation of fetal or neonatal condition, as recommended by the American Journal of Obstetrics and Gynecology 1.
Key Considerations
- The survival rate for infants born at 23 weeks of gestation is approximately 23-27% 1.
- Significant morbidity is universal among survivors, with 98-100% experiencing some form of impairment 1.
- A stepwise approach to care, concordant with neonatal circumstances and condition, and with parental wishes, is appropriate 1.
- Care should be reevaluated regularly and potentially redirected based on the evolution of the clinical situation 1.
Recommendations
- Assessment for resuscitation should be considered for fetuses at 23 weeks of gestation, rather than immediate resuscitation or deferral of care 1.
- Antenatal corticosteroids and tocolysis for preterm labor may be considered to allow for antenatal corticosteroid administration, but the evidence is limited 1.
- Magnesium sulfate for neuroprotection and antibiotics to prolong latency during expectant management of preterm PROM may also be considered, but the evidence is limited 1.
- Cesarean delivery for fetal indication may be considered, but the decision should be individualized based on specific clinical circumstances and family values and wishes 1.
Important Notes
- The approach to antenatal and postdelivery care may differ dramatically depending on parental preferences regarding resuscitation 1.
- A decision not to undertake resuscitation of a liveborn infant should not be seen as a decision to provide no care, but rather a decision to redirect care to comfort measures 1.
- Continuous electronic fetal heart rate monitoring may be considered if it is believed that intrauterine resuscitation will affect the newborn’s outcome 1.
From the Research
FGS 23 Overview
- FGS 23 is related to Fibroblast growth factor 23 (FGF23), a hormone that regulates phosphate and vitamin D metabolism 2, 3
- Excessive actions of FGF23 can cause hypophosphatemic rickets/osteomalacia, including tumor-induced osteomalacia (TIO) 2
- TIO is a paraneoplastic syndrome caused by overproduction of FGF23 from responsible tumors, and its treatment involves locating and removing the causative tumors 2
Diagnostic Modalities for FGF23-Producing Tumors
- Several imaging methods, including skeletal survey by magnetic resonance imaging and octreotide scintigraphy, have been used to identify FGF23-producing tumors 2
- Systemic venous sampling has been conducted to locate FGF23-producing tumors in suspected patients with TIO, showing potential benefits for a subset of patients 2
- Anti-FGF23 antibody therapy has been explored as a treatment for FGF23-related hypophosphatemic diseases, with promising results in phase I clinical trials 3
Other Studies
- A systematic review and meta-analysis of test accuracy for diagnosing suspected pulmonary embolism found that D-dimer assay, compression ultrasonography, computed tomography pulmonary angiography, and ventilation-perfusion scanning have varying degrees of sensitivity and specificity 4
- A study on long-circulating siRNA nanoparticles for validating Prohibitin1-targeted non-small cell lung cancer treatment demonstrated the potential of RNA interference for cancer therapy 5
- A study on five-year changes in 24-hour sleep-wake activity and dementia risk in oldest old women found that increasing sleepiness over 5 years was associated with doubled dementia risk 6