Perinatal practice in extreme premature delivery: variation in Dutch physicians’ preferences despite guideline
| Autor: | Arno van Heijst, Mallory Woiski, Rosa Geurtzen, Marije Hogeveen, Jos M. T. Draaisma, Hubertina C.J. Scheepers, Rosella P.M.G. Hermens |
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| Přispěvatelé: | Obstetrie & Gynaecologie, MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), RS: GROW - R4 - Reproductive and Perinatal Medicine |
| Rok vydání: | 2016 |
| Předmět: |
Male
Palliative care Psychological intervention Extreme prematurity 0302 clinical medicine Pregnancy Surveys and Questionnaires 030212 general & internal medicine Practice Patterns Physicians' Netherlands Palliative Care Gestational age Middle Aged Women's cancers Radboud Institute for Health Sciences [Radboudumc 17] Obstetrics Perinatal Care Premature birth Infant Extremely Premature Practice Guidelines as Topic Premature Birth Female Original Article Prenatal counseling Adult Limits of viability medicine.medical_specialty Resuscitation Decision Making Gestational Age Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] 03 medical and health sciences 030225 pediatrics Intensive care medicine Humans Pediatrics Perinatology and Child Health Neonatology Intensive care medicine Treatment decisions business.industry Other Research Radboud Institute for Health Sciences [Radboudumc 0] Infant Newborn Guideline medicine.disease Cross-Sectional Studies Family medicine Pediatrics Perinatology and Child Health Intensive Care Neonatal Small for gestational age business |
| Zdroj: | European Journal of Pediatrics, 175(8), 1039-1046. Springer, Cham European Journal of Pediatrics, 175, 8, pp. 1039-46 European Journal of Pediatrics European Journal of Pediatrics, 175, 1039-46 |
| ISSN: | 1432-1076 0340-6199 |
| DOI: | 10.1007/s00431-016-2741-7 |
| Popis: | Contains fulltext : 171156.pdf (Publisher’s version ) (Open Access) Decisions at the limits of viability about initiating care are challenging. We aimed to investigate physicians' preferences on treatment decisions, against the background of the 2010 Dutch guideline offering active care from 24(+0/7) weeks of gestational age (GA). Obstetricians' and neonatologists' opinions were compared. An online survey was conducted amongst all perinatal professionals (n = 205) of the 10 Dutch level III perinatal care centers. Response rate was 60 % (n = 122). Comfort care was mostly recommended below 24(+0/7) weeks and intensive care over 26(+0/7) weeks. The professional views varied most at 24 and 25 weeks, with intensive care recommended but comfort care at parental request optional being the median. There was a wide range in perceived lowest limits of GA for interventions as a caesarian section and a neonatologist present at birth. Obstetricians and neonatologists disagreed on the lowest limit providing chest compressions and administering epinephrine for resuscitation. The main factors restricting active treatment were presence of congenital disorders, "small for gestational age" fetus, and incomplete course of corticosteroids. CONCLUSION: There was a wide variety in individually preferred treatment decisions, especially when aspects were not covered in the Dutch guideline on perinatal practice in extreme prematurity. Furthermore, obstetricians and neonatologists did not always agree. WHAT IS KNOWN: * Cross-cultural differences exists in the preferred treatment at the limits of viability * In the Netherlands since 2010, intensive care can be offered starting at 24 (+0/7) weeks gestation What is new: * There was a wide variety in preferred treatment decisions at the limits of viability especially when aspects were not covered in the Dutch national guideline on perinatal practice in extreme prematurity. |
| Databáze: | OpenAIRE |
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