Dutch guidelines on care for extremely premature infants: Navigating between personalisation and standardization

Area of Science:

• Neonatal care
• Medical ethics
• Healthcare policy

Background:

• International guidelines for care at the limit of viability lack consensus.
• Current Dutch guidelines may not fully align with healthcare professional preferences.

Purpose of the Study:

• To determine the preferred guideline type for neonatal care at the limit of viability among Dutch healthcare professionals.
• To explore preferences regarding the "grey zone" and acceptable reasons for treatment variation.

Main Methods:

• A survey instrument was developed and distributed to Dutch healthcare professionals.
• The survey assessed preferences for different guideline types (none, gestational-age-based, gestational-age-based-plus, prognosis-based).
• Respondents provided input on the gestational age limits of the "grey zone" and attitudes towards treatment variation.

Main Results:

• A significant majority (72.8%) of the 769 respondents favored a gestational-age-based-plus guideline.
• The preferred "grey zone" limits were approximately 24 weeks as the lower bound and 26 weeks as the upper bound.
• Treatment variation was deemed acceptable if based on parental values, but not on hospital policy or physician opinion.

Conclusions:

• Dutch healthcare professionals show a preference for guidelines that incorporate individual factors beyond just gestational age.
• These findings suggest a potential need to revise current Dutch guidelines to better reflect professional consensus.
• Parental values are considered a key factor in acceptable treatment variations at the limit of viability.