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

Journal article

OBJECTIVE:
To examine international perspectives on the necessity of guidelines for the care of extremely preterm infants (EPIs), what forms such guidance should take, and the extent of practice variation neonatologists find acceptable.
STUDY DESIGN:
Anonymous, online, cross-sectional international survey among neonatologists, exploring current and preferred guidelines and hypothetical scenarios testing acceptance of practice variation in EPI decision-making.
RESULTS:
We analyzed 127 responses from 47 countries. Most respondents (55%) preferred a guideline using gestational age (GA) alongside other prognostic factors; 13% preferred no guideline. In scenarios involving borderline viability, variation was accepted when based on parental wishes, cultural norms, or resource constraints, but not when reflecting hospitals or individual differences. Views on directive counseling were divided.
CONCLUSIONS:
Neonatologists support flexible, structured guidelines that consider more than GA alone. Variation is acceptable when reflecting parental values, cultural norms, or resource constraints but not when driven by individual or institutional preferences.

Authors: Geurtzen, R; Klijntjes, S; Stegeman, M; Hogeveen, M; Verhagen, AAEE

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Springer Nature
• Journal: Journal of Perinatology
• Article number: 41372
• Place of publication: United States
• Publication date: 2026-02-10
• Acceptance date: 2026-01-27
• DOI: 10.1038/s41372-026-02581-5
• EISSN: 1476-5543
• ISSN: 0743-8346
• Pmid: 41667625
• Language: English