Limits...
Perinatal practice in extreme premature delivery: variation in Dutch physicians' preferences despite guideline.

Geurtzen R, Draaisma J, Hermens R, Scheepers H, Woiski M, van Heijst A, Hogeveen M - Eur. J. Pediatr. (2016)

Bottom Line: Obstetricians' and neonatologists' opinions were compared.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. • 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Radboud university medical center Amalia Children's Hospital, Nijmegen, The Netherlands. Rosa.Geurtzen@radboudumc.nl.

ABSTRACT

Unlabelled: 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.

No MeSH data available.


Related in: MedlinePlus

Personal limits of various interventions that could be taken around a possible premature delivery neonatologist = * obstetrician = o xx %/xx % = proportion of neonatologist/proportion of obstetricians
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Related In: Results  -  Collection


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Fig2: Personal limits of various interventions that could be taken around a possible premature delivery neonatologist = * obstetrician = o xx %/xx % = proportion of neonatologist/proportion of obstetricians

Mentions: Professionals were asked for their personal lower limits for certain interventions or decisions at extreme prematurity (Fig. 2). Answer options ranged from “starting at 22+0/7 weeks GA” through “starting at 26+0/7 weeks GA”; only at 23 weeks more detailed answer options were available (23+0/7, 23+4/7, and 23+5/7 weeks GA). There was variation between individuals up to 4 weeks. Medians in weeks GA (for this lower limit) were as mentioned below and interquartile ranges (IQR) are provided (obstetricians and neonatologists had the same median except where otherwise stated):Fig. 2


Perinatal practice in extreme premature delivery: variation in Dutch physicians' preferences despite guideline.

Geurtzen R, Draaisma J, Hermens R, Scheepers H, Woiski M, van Heijst A, Hogeveen M - Eur. J. Pediatr. (2016)

Personal limits of various interventions that could be taken around a possible premature delivery neonatologist = * obstetrician = o xx %/xx % = proportion of neonatologist/proportion of obstetricians
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4930484&req=5

Fig2: Personal limits of various interventions that could be taken around a possible premature delivery neonatologist = * obstetrician = o xx %/xx % = proportion of neonatologist/proportion of obstetricians
Mentions: Professionals were asked for their personal lower limits for certain interventions or decisions at extreme prematurity (Fig. 2). Answer options ranged from “starting at 22+0/7 weeks GA” through “starting at 26+0/7 weeks GA”; only at 23 weeks more detailed answer options were available (23+0/7, 23+4/7, and 23+5/7 weeks GA). There was variation between individuals up to 4 weeks. Medians in weeks GA (for this lower limit) were as mentioned below and interquartile ranges (IQR) are provided (obstetricians and neonatologists had the same median except where otherwise stated):Fig. 2

Bottom Line: Obstetricians' and neonatologists' opinions were compared.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. • 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.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics, Radboud university medical center Amalia Children's Hospital, Nijmegen, The Netherlands. Rosa.Geurtzen@radboudumc.nl.

ABSTRACT

Unlabelled: 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.

No MeSH data available.


Related in: MedlinePlus