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Current attitudes and beliefs toward perinatal care orientation before 25 weeks of gestation: The French perspective
Odile Dicky1, Sonia Dahan2, Audrey Reynaud3
1Neonatal Intensive Care Unit, University Hospital, Toulouse, France; UMR 1027 INSERM, Paul Sabatier University, Toulouse, France.
Insights
French infant survival rates before 25 weeks are critically low. Neonatologists desire improved care, but barriers like resource limitations and lack of expertise hinder progress in neonatal intensive care.
Area of Science:
- Perinatal Medicine
- Neonatology
- Public Health
Background:
- Infant survival rates at 22-24 weeks gestational age in France are notably low compared to international benchmarks.
- Suboptimal regionalization and practice variations contribute to inconsistent perinatal care.
- Parental experiences with conflicting information erode trust in the healthcare system.
Purpose of the Study:
- To investigate neonatologists' perspectives on current perinatal management practices.
- To identify barriers and facilitators for improving care for extremely preterm infants.
- To inform strategies for enhancing survival rates and quality of care.
Main Methods:
- A national survey exploring neonatologists' views on care practices and outcomes.
- Analysis of open-ended responses to identify themes related to care improvement.
- Review of existing data on regionalization and resource allocation.
Main Results:
- 81% of neonatologists reported increased active care and improved survival rates since 2011.
- A significant portion still favor comfort care for infants at or before 24 weeks.
- Barriers identified include lack of expertise, absence of benchmarking, and limited NICU/follow-up resources.
Conclusions:
- While many neonatologists aim for improved outcomes, significant challenges impede active care.
- Optimizing regionalization, fostering teamwork, and enhancing parental involvement are crucial.
- Establishing specialized perinatal centers and promoting benchmarking can drive better long-term results.
Abstract:
The survival rate of infants born before 25 weeks of gestational age in France is extremely low compared with that of many other countries: 0%, 1%, and 31% at 22, 23, and 24 weeks' in the last national cohort study. A non-optimal regionalization and variations in practice are prevalent. Some parents in social media and support groups have reported feeling lost and confused with mixed messages leading to lack of trust. These data kindled a major debate in France around perinatal management leading to an investigation exploring neonatologists' perspectives and ways to improve care. The majority (81%) of the responding neonatologists reported more active care and higher survival rates than in 2011, although others continued preferring delivery room comfort care and limited NICU treatment at or before 24 weeks. The desire to improve was an overarching theme in all the respondents' answers to open-ended questions. Barriers to active care included an absence of expertise and of benchmarking to guide optimal care, and limited resources in the NICU and during follow-up - all leading to self-fulfilling prophecies of poor prognosis. Optimization of regionalization, perinatal teamwork and parental involvement, fostering experience by creating specific perinatal centers, stimulating benchmarking, and working with policy makers to allow better long-term outcomes could enable higher survival.
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