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

Decisions at the limits of viability about initiating care are challenging. We aimed to investigate physicians' preferences on treatment decisions, against the background of the 2010 Dutch guideline offering active care from 24(+0/7) weeks of gestational age (GA). Obstetricians' and neonatologists' opinions were compared. An online survey was conducted amongst all perinatal professionals (n = 205) of the 10 Dutch level III perinatal care centers. Response rate was 60 % (n = 122). Comfort care was mostly recommended below 24(+0/7) weeks and intensive care over 26(+0/7) weeks. The professional v... Mehr ...

Verfasser: Geurtzen, Rosa
Draaisma, Jos
Hermens, Rosella
Scheepers, Liesbeth
Woiski, Mallory
van Heijst, Arno
Hogeveen, Marije
Dokumenttyp: Artikel
Erscheinungsdatum: 2016
Reihe/Periodikum: Geurtzen , R , Draaisma , J , Hermens , R , Scheepers , L , Woiski , M , van Heijst , A & Hogeveen , M 2016 , ' Perinatal practice in extreme premature delivery: variation in Dutch physicians' preferences despite guideline ' , European Journal of Pediatrics , vol. 175 , no. 8 , pp. 1039-1046 . https://doi.org/10.1007/s00431-016-2741-7
Schlagwörter: Limits of viability / Prenatal counseling / Extreme prematurity / Treatment decisions / Resuscitation
Sprache: Englisch
Permalink: https://search.fid-benelux.de/Record/base-26664301
Datenquelle: BASE; Originalkatalog
Powered By: BASE
Link(s) : https://cris.maastrichtuniversity.nl/en/publications/72660661-6934-4b18-856f-855ed63e4213

Decisions at the limits of viability about initiating care are challenging. We aimed to investigate physicians' preferences on treatment decisions, against the background of the 2010 Dutch guideline offering active care from 24(+0/7) weeks of gestational age (GA). Obstetricians' and neonatologists' opinions were compared. An online survey was conducted amongst all perinatal professionals (n = 205) of the 10 Dutch level III perinatal care centers. Response rate was 60 % (n = 122). Comfort care was mostly recommended below 24(+0/7) weeks and intensive care over 26(+0/7) weeks. The professional views varied most at 24 and 25 weeks, with intensive care recommended but comfort care at parental request optional being the median. There was a wide range in perceived lowest limits of GA for interventions as a caesarian section and a neonatologist present at birth. Obstetricians and neonatologists disagreed on the lowest limit providing chest compressions and administering epinephrine for resuscitation. The main factors restricting active treatment were presence of congenital disorders, "small for gestational age" fetus, and incomplete course of corticosteroids. Conclusion: There was a wide variety in individually preferred treatment decisions, especially when aspects were not covered in the Dutch guideline on perinatal practice in extreme prematurity. Furthermore, obstetricians and neonatologists did not always agree.