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Swiss Recommendations for the Perinatal Care of Extremely Low Gestational Age Neonates
Thomas M Berger1, Markus Hodel2, Giancarlo Natalucci3
1NEO FOR NAMIBIA - Helping Babies Survive, Lucerne, Switzerland.
Insights
Revised Swiss guidelines for extremely low gestational age neonates (ELGANs) emphasize individualized risk assessment and shared decision-making, moving beyond gestational age alone. Care trajectories now include palliative or survival-focused options based on patient best interest.
Area of Science:
- Neonatal Medicine
- Perinatal Care
- Pediatric Critical Care
Background:
- The 2011 Swiss recommendations for extremely low gestational age neonates (ELGANs) required updating.
- Advances in neonatal medicine necessitate revised guidelines for optimal care.
Purpose of the Study:
- To revise the 2011 Swiss recommendations for the perinatal care of ELGANs.
- To incorporate current evidence and expert consensus into updated guidelines.
Main Methods:
- Systematic literature review of recent publications.
- Expert consensus from multidisciplinary specialists in ELGAN care.
- Iterative discussion and revision process by a working group.
Main Results:
- Revised recommendations prioritize individualized risk assessment and shared decision-making.
- Infants <23 0/7 weeks gestation receive comfort-focused palliative care.
- Infants ≥23 0/7 weeks gestation require individualized risk assessment beyond gestational age, considering modifiable and non-modifiable factors.
Conclusions:
- Management for ELGANs follows three trajectories: comfort-focused palliative care, survival-focused care, or a hybrid approach with parental involvement.
- Decision-making must consider the infant's best interest, moving away from sole reliance on gestational age.
- Parental preferences are integral to care planning and must be respected and supported.
Aim:
To revise the 2011 Swiss recommendations for the perinatal care of extremely low gestational age neonates (ELGANs).
Methods:
Based on review of recent literature, experts from various medical specialties involved in the perinatal care of ELGANs made suggestions for revisions. Following discussions, changes accepted by the whole working group were incorporated into the revised manuscript.
Results:
The revised recommendations highlight the importance of individualised risk assessment and emphasise the importance of shared decision-making. While the care of preterm infants with a gestational age below 23 0/7 weeks should be limited to comfort-focused palliative care, risk assessment in preterm infants with a gestational age ≥ 23 0/7 weeks must be individualised by considering additional non-modifiable and modifiable risk factors; decision-making based on gestational age alone must be abandoned.
Conclusions:
Management options for ELGANs will fall into three different trajectories. First, if survival-focused care is not in the patient's best interest, preference should be given to comfort-focused palliative care. Second, if survival-focused care clearly is in the patient's best interest, survival-focused care will be provided. Third, if the patient's best interest is uncertain, both survival-focused and comfort-focused palliative care can be considered and parental preferences must be explored, respected, and supported.
