Staff views on the management of the extremely preterm infant

To explore the opinions of different healthcare professionals about the use of interventions and outcome in extremely preterm labour.

This was a prospective questionnaire survey. A structured questionnaire was mailed to 142 obstetricians, neonatologists, midwives and neonatal nurses working at City Hospital and Queen's Medical Centre, Nottingham, UK. The current opinions of practice of the healthcare professionals in their antenatal and intrapartum management of a woman with an extremely preterm infant were sought.

The overall response was 49% (n=69) after two mailings. Most respondents overestimated infant survival and underestimated intact infant survival rates. Neonatal staff were most likely to wish to use electronic fetal monitoring and administer corticosteroids at the lower extreme gestations. There was no consensus on when to use corticosteroids. Consultant obstetricians were expected to be responsible for counselling parents before delivery, when time allows, but their presence at delivery was not thought to be essential. Neonatal nurses would recommend in utero transfer for women more readily at lower gestations whereas midwives were more reluctant to accept these women as in utero transfers. There were no significant differences in the attitudes to resuscitation of the extremely preterm infant among the different professionals. The median birthweights at which active resuscitation should be commenced ranged from 400 g for neonatal nurses to 500 g for midwives.

Different professional groups perceive outcome differently and this may affect willingness to use interventions at borderline viability. Generally, neonatal staff wished to be more interventional at 21-23 weeks of gestation.