Survey shows marked variations in approaches to redirection of care for critically ill very preterm infants in 11 countries

Area of Science:

• Neonatalogy
• Pediatric Critical Care
• Medical Ethics

Background:

• Critically ill very preterm infants require specialized care in neonatal intensive care units (NICUs).
• International comparisons of infant outcomes are complicated by variations in clinical practices.

Purpose of the Study:

• To survey and identify differences in care practices for critically ill very preterm infants across the International Network for Evaluating Outcomes in Neonates (iNeo).
• To understand how varying care approaches influence outcome comparisons in neonatal intensive care.

Main Methods:

• An online survey was distributed to 390 NICUs in 11 countries in 2015.
• Care practices for very preterm infants and those with severe intracranial hemorrhage (ICH) were surveyed.
• Survey data were compared with network incidence of death and severe ICH for infants born between 23 and 28 weeks gestation.

Main Results:

• Significant inter-network differences in care approaches were identified.
• Some NICUs favored withholding care for futility, while others favored redirection of care.
• Redirection of care for severe ICH was frequent in some networks (e.g., Australia, New Zealand, Switzerland) but rare in others, correlating with lower rates of survivors with severe ICH.

Conclusions:

• Marked inter-network variations in care strategies for critically ill neonates exist.
• These differences in care approaches must be considered when comparing neonatal outcomes across different regions or units.