Are guidelines needed? International perspectives on decision-making and practice variation in the care of extremely...

Area of Science:

• Neonatal medicine
• Medical ethics
• Healthcare policy

Background:

• Guidelines for extremely preterm infant (EPI) care are crucial for consistent management.
• International perspectives on the necessity and form of these guidelines are not well-established.
• Understanding acceptable practice variation is key to developing universally applicable guidelines.

Purpose of the Study:

• To assess international neonatologist views on the need for EPI care guidelines.
• To determine preferred structures for such guidelines, including factors beyond gestational age.
• To evaluate the extent of practice variation neonatologists deem acceptable in EPI decision-making.

Main Methods:

• An anonymous, online, cross-sectional international survey was conducted.
• The survey targeted neonatologists globally, exploring current and preferred guidelines.
• Hypothetical scenarios were used to test acceptance of practice variation in EPI care.

Main Results:

• 127 neonatologists from 47 countries responded.
• 55% favored guidelines combining gestational age with other prognostic factors; 13% preferred no guidelines.
• Practice variation was accepted for parental wishes, cultural norms, or resource constraints, but not for hospital or individual differences.

Conclusions:

• Neonatologists advocate for adaptable, structured guidelines for EPIs, considering multiple prognostic factors.
• Acceptable practice variation in EPI care is linked to ethical considerations like parental values and resource allocation.
• Guidelines should accommodate contextual factors rather than institutional or individual variability.