An alternative approach to developing guidelines for the management of an anticipated extremely preterm infant
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Nicholas Williams
Abstract
Objectives
To identify the probability of survival and severe neurodevelopmental impairment (sNDI) at which perinatal physicians would or would not offer or recommend resuscitation at birth for extremely preterm infants.
Methods
A Delphi process consisting of five rounds was implemented to seek consensus (>80% agreement) amongst British Columbia perinatal physicians. The first-round consisted of neonatal and maternal-fetal-medicine Focus Groups. Rounds two to five surveyed perinatal physicians, building upon previous rounds. Draft guidelines were developed and agreement sought.
Results
Based on 401 responses across all rounds, consensus was obtained that resuscitation should not be offered if survival probability <5%, not recommended if survival probability 5 to <10%, resuscitation recommended if survival without sNDI probability >70 to 90% and resuscitation standard care if survival without sNDI >90%.
Conclusions
This physician consensus-based, objective framework for the management of an anticipated extremely preterm infant is a transparent alternative to existing guidelines, minimizing gestational-ageism and allowing for individualized management utilizing up-to-date data. Further input from other key stakeholders will be required prior to guideline implementation.
Acknowledgments
We would like to thank the perinatal health care providers of British Columbia for their participation and invaluable feedback.
Research funding: None declared.
Author contributions: NW: Study design and planning, survey development and implementation, data analysis, drafting and editing of manuscript. AS: Study design and planning, data analysis, manuscript editing. CO: Study design and planning, survey development and implementation, data analysis, contributed to development and manuscript editing. SA: Study design and planning, data analysis, manuscript editing. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: Ethics approval was obtained from the BC Children’s and Women’s Hospital Research Ethics Board (#H16-00955-A005). Focus Group participants and survey respondents were informed that participation was voluntary, and they could leave at any time or choose not to complete any questions respectively.
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Supplementary Material
The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2019-0444).
© 2020 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
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- Mini Review
- Cervical insufficiency: a noteworthy disease with controversies
- Original Articles – Obstetrics
- Individualized birth length and head circumference percentile charts based on maternal body weight and height
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- Original Articles – Newborns
- Comparison of image quality in brain MRI with and without MR compatible incubator and predictive value of brain MRI at expected delivery date in preterm babies
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Artikel in diesem Heft
- Frontmatter
- Review
- Perinatal outcomes in vanishing twin pregnancies following assisted reproductive technology (ART) – a systematic review and meta-analysis
- Mini Review
- Cervical insufficiency: a noteworthy disease with controversies
- Original Articles – Obstetrics
- Individualized birth length and head circumference percentile charts based on maternal body weight and height
- Cellular immune responses in amniotic fluid of women with a sonographic short cervix
- Comparison of buprenorphine and methadone in the management of maternal opioid use disorder in full term pregnancies
- Influence of newborn head circumference and birth weight on the delivery mode of primipara: what is more important?
- Estimated fetal weight and severe neonatal outcomes in preterm prelabor rupture of membranes
- Which technique is better to place a manoeuvrable vacuum extractor cup on the flexion point? Vacca vs. Bird technique
- Pregnancy-specific transcriptional changes upon endotoxin exposure in mice
- Effects of nifedipine on fetal cardiac function in preterm labor
- Violence against trainees: urgent ethical challenges for medical educators and academic leaders in perinatal medicine
- Original Articles – Newborns
- Comparison of image quality in brain MRI with and without MR compatible incubator and predictive value of brain MRI at expected delivery date in preterm babies
- Survey on clinical use and non-use of recombinant human erythropoietin in European neonatal units
- An alternative approach to developing guidelines for the management of an anticipated extremely preterm infant
