Perinatal practice in extreme premature delivery: variation in Dutch physicians’ preferences despite guideline

Geurtzen, Rosa; Draaisma, J. M. T.; Hermens, Rosella; Scheepers, Hubertina; Woiski, Mallory; Heijst, Arno van; Hogeveen, Marije

doi:10.1007/s00431-016-2741-7

Cited by 33 publications

(41 citation statements)

References 34 publications

(69 reference statements)

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“…There is broad agreement in developed countries that all deliveries above 26 weeks should receive active perinatal care, whereas in 2011 there was greater variation at 24 and 25 weeks in France and elsewhere. For example, the attitudes of Dutch health care professionals varies most towards births at 24 and 25 weeks' gestation [35], and the largest differences in survival seen in five European regions were at 24 weeks' gestation, with much greater consistency in outcomes above this gestational age [36].…”

Section: Study Findings In Contextmentioning

confidence: 99%

Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort study

et al. 2020

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Background: Perinatal decision-making affects outcomes for extremely preterm babies (22-26 weeks' gestational age (GA)): more active units have improved survival without increased morbidity. We hypothesised such units may gain skills and expertise meaning babies at higher gestational ages have better outcomes than if they were born elsewhere. We examined mortality and morbidity outcomes at age two for babies born at 27-28 weeks' GA in relation to the intensity of perinatal care provided to extremely preterm babies. Methods: Fetuses from the 2011 French national prospective EPIPAGE-2 cohort, alive at maternal admission to a level 3 hospital and delivered at 27-28 weeks' GA, were included. Morbidity-free survival (survival without sensorimotor (blindness, deafness or cerebral palsy) disability) and overall survival at age two were examined. Sensorimotor disability and Ages and Stages Questionnaire (ASQ) result below threshold among survivors were secondary outcomes. Perinatal care intensity level was based on birth hospital, grouped using the ratio of 24-25 weeks' GA babies admitted to neonatal intensive care to fetuses of the same gestation alive at maternal admission. Sensitivity analyses used ratios based upon antenatal steroids, Caesarean section, and newborn resuscitation. Multiple imputation was used for missing data; hierarchical logistic regression accounted for births nested within centres. Results: 633 of 747 fetuses (84.7%) born at 27-28 weeks' GA survived to age two. There were no differences in survival or morbidity-free survival: respectively, fully adjusted odds ratios were 0.96 (95% CI: 0.54 to 1.71) and 1.09 (95% CI: 0.59 to 2.01) in medium and 1.12 (95% CI: 0.63 to 2.00) and 1.16 (95% CI: 0.62 to 2.16) in high compared to low-intensity hospitals. Among survivors, there were no differences in sensorimotor disability or ASQ below threshold. Sensitivity analyses were consistent with the main results.

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Section: Study Findings In Contextmentioning

confidence: 99%

Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort study

et al. 2020

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“…Statistics may not always be of additional value to parents. Boss found that physicians’ predictions of morbidity and death are not central to parental decision-making regarding delivery room resuscitation [ 33 ]. Janvier rightly appoints the disadvantages of using statistics, i.e.…”

Section: Discussionmentioning

confidence: 99%

“…We developed the current survey in three stages just as described elsewhere. The first version was based on a combination of literature on prenatal counselling, several prenatal counselling surveys that were kindly shared with us [ 5 , 16 , 17 , 33 – 35 ], observations from previous Dutch studies [ 28 ], and on public discussions generated by the Dutch guideline on perinatal practice in extreme premature delivery [ 27 ]. This survey was improved in two Delphi rounds containing both four team members and two independent professionals.…”

Section: Methodsmentioning

confidence: 99%

Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals

Geurtzen

Heijst

Hermens

et al. 2018

BMC Pregnancy Childbirth

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BackgroundSince 2010, intensive care can be offered in the Netherlands at 24+0 weeks gestation (with parental consent) but the Dutch guideline lacks recommendations on organization, content and preferred decision-making of the counselling. Our aim is to explore preferred prenatal counselling at the limits of viability by Dutch perinatal professionals and compare this to current care.MethodsOnline nationwide survey as part of the PreCo study (2013) amongst obstetricians and neonatologists in all Dutch level III perinatal care centers (n = 205).The survey regarded prenatal counselling at the limits of viability and focused on the domains of organization, content and decision-making in both current and preferred practice.ResultsOne hundred twenty-two surveys were returned out of 205 eligible professionals (response rate 60%). Organization-wise: more than 80% of all professionals preferred (but currently missed) having protocols for several aspects of counselling, joint counselling by both neonatologist and obstetrician, and the use of supportive materials. Most professionals preferred using national or local data (70%) on outcome statistics for the counselling content, in contrast to the international statistics currently used (74%). Current decisions on initiation care were mostly made together (in 99% parents and doctor). This shared decision model was preferred by 95% of the professionals.ConclusionsDutch perinatal professionals would prefer more protocolized counselling, joint counselling, supportive material and local outcome statistics. Further studies on both barriers to perform adequate counselling, as well as on Dutch outcome statistics and parents’ opinions are needed in order to develop a national framework.Trial registrationClinicaltrials.gov, NCT02782650, retrospectively registered May 2016.Electronic supplementary materialThe online version of this article (10.1186/s12884-017-1644-6) contains supplementary material, which is available to authorized users.

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“…The decision to begin life‐sustaining treatment (LST) on critically ill neonates is an internationally debated issue that continues to provoke widespread discussion . The care of babies born at the threshold of viability raises questions about their chances of survival and about their expected quality of life .…”

Section: Introductionmentioning

confidence: 99%

Opinions of Argentinean neonatologists on the initiation of life‐sustaining treatment in preterm infants

Silberberg

Villar

Torres

2018

Health Science Reports

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BackgroundIn June 2014, the Argentinean Ministry of Health published guidelines for the management of neonates born at the limit of viability (≤25 weeks of gestation). We explored the opinion of neonatologists in Buenos Aires, Argentina, regarding the initiation of life‐sustaining treatment (LST) in critically ill neonates, focusing on the effect of sociocultural factors on their opinion.MethodsAn anonymous survey was designed to explore the opinions of Argentinean neonatologists on whether or not to initiate LST in newborns born prematurely. Five hundred eighty neonatologists from 36 neonatal units were invited to participate, and 315 specialists from 34 neonatal units completed the survey (response rate 54%). The survey was conducted between June 2014 and February 2015.Results9.5% (30/315) of the neonatologists answered they would begin LST on neonates born at 22 weeks, 42.5% (134/315) at 23 weeks, 37% (117/315) at 24 weeks, 7% (22/315) at 25 weeks, and 4% (12/315) at ≥26 weeks. Cumulatively then, 96% of participants stated they would start LST at 25 weeks of gestation or less. On multivariate analysis, a “transcendent” value of life and lack of consideration of the local legal framework for making medical decisions in the delivery room were statistically associated with an opinion in favor of initiation of LST in neonates born at the limit of viability. More than 50% of the Argentinean neonatologists surveyed answered they would initiate treatment at a gestational age of less than 23 weeks, despite the fact that the recommendations of the Argentinean Ministry of Health are to only give comfort care for these neonates. The opinion of most Argentinean neonatologists surveyed thus differs from that recommended by the guidelines of Argentina.ConclusionThe most frequent opinion of Argentinean neonatologists was to initiate LST in neonates at the limit of viability. Certain factors, in particular the sense of a transcendent meaning to life and lack of consideration of the local legal framework for making medical decisions in the delivery room, seem to influence the decision to start LST.

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Perinatal practice in extreme premature delivery: variation in Dutch physicians’ preferences despite guideline

Cited by 33 publications

References 34 publications

Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort study

Intensity of perinatal care for extremely preterm babies and outcomes at a higher gestational age: evidence from the EPIPAGE-2 cohort study

Preferred prenatal counselling at the limits of viability: a survey among Dutch perinatal professionals

Opinions of Argentinean neonatologists on the initiation of life‐sustaining treatment in preterm infants

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