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Decision-making around resuscitation of extremely preterm infants in the Philippines: A consensus guideline
Dominic Jc Wilkinson1,2,3, Maria Esterlita Villanueva-Uy4,5,6, Dean Hayden1
1Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom.
Insights
This study developed the first national guidelines for extremely preterm infants (EPIs) in the Philippines, emphasizing parental wishes and resource availability for infant resuscitation decisions. The guidelines support active or palliative management based on individual circumstances and advocate for improved healthcare delivery.
Area of Science:
- Neonatal Medicine
- Public Health Policy
- Medical Ethics
Background:
- Existing guidelines for extremely preterm infants (EPIs) primarily serve high-income nations.
- The Philippines, facing a high burden of preterm births, lacked national guidelines for EPI care.
- Resource disparities in low- and middle-income countries necessitate context-specific approaches.
Purpose of the Study:
- To develop the first national guidelines for the decision-making and resuscitation of extremely preterm infants (EPIs) in the Philippines.
- To establish consistent and ethical care practices for EPIs, considering local context and resource availability.
- To address the ethical concerns of resource disparities in neonatal care.
Main Methods:
- A working group from the Philippine Society of Newborn Medicine conducted a comprehensive review.
- Data on EPI outcomes in the Philippines were analyzed.
- Surveys of pediatricians and neonatologists informed a consensus workshop.
Main Results:
- The guidelines promote consistent decision-making, integrating parental views and resource availability.
- Active management is recommended for viable preterm infants at high risk, contingent on parental consent and resources.
- Palliative care is endorsed when parents opt to withhold active management.
- A "grey zone" for neonatal resuscitation (24-28 weeks gestation) was established, reflecting LMIC contexts.
Conclusions:
- The developed guidelines provide a framework for managing extremely preterm infants in the Philippines.
- The guidelines emphasize shared decision-making, respecting parental autonomy and resource limitations.
- Addressing resource disparities is crucial for equitable neonatal care and necessitates advocacy for improved healthcare delivery.
Abstract:
While the vast majority of preterm births globally occur in low- and middle-income countries, existing published guidelines relating to the decision-making and resuscitation of extremely preterm infants (EPIs) largely focus on high-income countries. In 2018-2019, a working group of the Philippine Society of Newborn Medicine aimed to develop the first national guideline relating to the care of EPIs. The working group reviewed data on the outcomes of EPIs in the Philippines, surveyed paediatricians and neonatologists in the Philippines about current practice and held a consensus workshop. This paper describes the guideline development process and presents a summary of the guidelines. The national guidelines endorse consistency in decision-making. Health professionals should take into consideration the views and wishes of the infant's parents and the availability of resources to treat the newborn infant. Active management would be appropriate to provide for potentially viable preterm infants at moderate to high risk of poor outcomes, where parents have expressed their wish for this management (and where there are resources available to provide this treatment). For such infants, where parents have expressed their wish to withhold active management, palliative management would also be appropriate to provide. The guideline endorses a grey zone for neonatal resuscitation from approximately 24 to 28 weeks' gestation in the Philippines, reflecting the context for resuscitation in low- and middle-income countries. Disparities in resource availability are themselves an ethical concern for neonatologists and should be a stimulus for advocacy and improvements in health-care delivery.
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