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Published on: November 20, 2015
Treatment choices for extremely preterm infants: an international perspective
R De Leeuw1, M Cuttini, M Nadai
1Department of Neonatology, Amsterdam University, Amsterdam, The Netherlands.
Insights
Treatment decisions for extremely premature infants vary significantly across 11 European countries. While most physicians would initiate intensive care, subsequent treatment choices, especially after complications, differ by nation, impacting ethical debates on borderline viability.
Area of Science:
- Neonatal Medicine
- Medical Ethics
- Comparative Healthcare Research
Background:
- Extreme prematurity presents complex ethical and clinical challenges.
- Variations in neonatal care practices exist across different European countries.
Purpose of the Study:
- To compare treatment decisions made by neonatal physicians and nurses for a hypothetical case of extreme prematurity (24 weeks' gestation).
- To identify country-specific variations in managing extremely premature infants.
Main Methods:
- Anonymous, self-administered questionnaires distributed to 1401 physicians and 3425 nurses.
- Data collected from 143 neonatal intensive care units across 11 European countries.
Main Results:
- Most physicians would initiate resuscitation and intensive care for extremely premature infants.
- Treatment continuation decisions diverge significantly after clinical deterioration, with variations by country.
- Nurses showed a higher tendency to withhold resuscitation and consider parental opinions compared to physicians.
Conclusions:
- Physicians generally consider extremely premature infants viable, but decision-making patterns vary post-deterioration.
- Findings highlight the need for ethical discussions on borderline viability and international statistical comparisons.
- Country-specific factors influence treatment choices for extremely premature infants.
Objective:
To compare treatment choices of neonatal physicians and nurses in 11 European countries for a hypothetical case of extreme prematurity (24 weeks' gestational age, birth weight of 560 g, Apgar score of 1 at 1 minute).
Study Design:
An anonymous, self-administered questionnaire was completed by 1401 physicians (response rate, 89%) and 3425 nurses (response rate, 86%) from a large, representative sample of 143 European neonatal intensive care units. Italy, Spain, France, Germany, the Netherlands, Luxembourg, Great Britain, Sweden, Hungary, Estonia, and Lithuania participated.
Results:
Most physicians in every country but the Netherlands would resuscitate this baby and start intensive care. On subsequent deterioration of clinical conditions caused by a severe intraventricular hemorrhage, attitudes diverge: most neonatologists in Germany, Italy, Estonia, and Hungary would favor continuation of intensive care, whereas in the other countries some form of limitation of treatment would be the preferred choice. Parental wishes appear to play a role especially in Great Britain and the Netherlands. Nurses are more prone than doctors to withhold resuscitation in the delivery room and to ask parental opinion regarding subsequent treatment choices.
Conclusion:
An extremely premature infant is regarded as viable by most physicians, whereas after deterioration of the clinical conditions decision-making patterns vary according to country. These findings have implications for the ethical debate surrounding treatment of infants of borderline viability and for the interpretation and comparison of international statistics.
