Thresholds for resuscitation of extremely preterm infants in the UK, Sweden, and Netherlands

Journal article

Background It is widely acceptable to involve parents in decision-making about resuscitation for extremely preterm infants (EPI) in the ‘grey zone’. However, there are different views about where the boundaries of the grey zone should lie. The aim of this study was to compare resuscitation thresholds for EPI between neonatologists in UK, Sweden and the Netherlands. Methods We distributed an online survey to consultant neonatologists and neonatal registrars/fellows with clinical scenarios in which parents requested resuscitation/non-resuscitation. Respondents were asked about the lowest gestational age/worst prognosis at which they would provide resuscitation and about the highest gestational age/best prognosis at which they would withhold resuscitation. Further scenarios assessed influence of the condition at birth, or consideration of available healthcare resources. Results The survey was completed by 162 neonatologists (30% response rate). There was a significant difference between countries; the grey zone for most UK respondents was 23.0 – 23.6/24 weeks, compared with 22.0 - 22.6/23 weeks in Sweden and 24.0-25.6/26 weeks in Netherlands. Resuscitation thresholds were higher if an infant was born in poor condition. There was wide variation in the prognosis that warranted resuscitation/non-resuscitation. Consideration of resource scarcity did not alter responses. Conclusions This survey found significant differences in approach to resuscitation of EPI with a spectrum from most (Sweden) to least proactive (Netherlands). Most survey respondents indicated shifts in decision-making attached to particular weeks of gestation. Despite the different approaches to decisions in the three countries, there was relatively little difference between countries in neonatologists’ prognostic thresholds for resuscitation.

Authors: Wilkinson, D; Verhagen, E; Johansson, S

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: American Academy of Pediatrics
• Journal: Pediatrics
• Volume: 142
• Issue: S1
• Pages: S574-S584
• Publication date: 2018-08-31
• Acceptance date: 2018-05-09
• DOI: 10.1542/peds.2018-0478I
• EISSN: 1098-4275
• ISSN: 0031-4005