Viability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionals
<p><strong>Background</strong> Decisions about treatments for extremely preterm infants (EPIs) born in the ‘grey zone’ of viability can be ethically complex. This 2020 survey aimed to determine views of UK neonatal staff about thresholds for treatment of EPIs given a recently revis...
| Main Authors: | , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
BMJ Publishing Group
2021
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| _version_ | 1826258789249056768 |
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| author | Di Stefano, L Wood, K Mactier, H Bates, S Wilkinson, D |
| author_facet | Di Stefano, L Wood, K Mactier, H Bates, S Wilkinson, D |
| author_sort | Di Stefano, L |
| collection | OXFORD |
| description | <p><strong>Background</strong> Decisions about treatments for extremely preterm infants (EPIs) born in the ‘grey zone’ of viability can be ethically complex. This 2020 survey aimed to determine views of UK neonatal staff about thresholds for treatment of EPIs given a recently revised national Framework for Practice from the British Association of Perinatal Medicine.</p>
<p><strong>Methods</strong> The online survey requested participants indicate the lowest gestation at which they would be willing to offer active treatment and the highest gestation at which they would withhold active treatment of an EPI at parental request (their lower and upper thresholds). Relative risks were used to compare respondents’ views based on profession and neonatal unit designation. Further questions explored respondents’ conceptual understanding of viability.</p>
<p><strong>Results</strong>336 respondents included 167 consultants, 127 registrars/fellows and 42 advanced neonatal nurse practitioners (ANNPs). Respondents reported a median grey zone for neonatal resuscitation between 22+1 and 24+0 weeks’ gestation. Registrars/fellows were more likely to select a lower threshold at 22+0 weeks compared with consultants (Relative Risk (RR)=1.37 (95% CI 1.07 to 1.74)) and ANNPs (RR=2.68 (95% CI 1.42 to 5.06)). Those working in neonatal intensive care units compared with other units were also more likely to offer active treatment at 22+0 weeks (RR=1.86 (95% CI 1.18 to 2.94)). Most participants understood a fetus/newborn to be ‘viable’ if it was possible to survive, regardless of disability, with medical interventions accessible to the treating team.</p>
<p><strong>Conclusion</strong> Compared with previous studies, we found a shift in the reported lower threshold for resuscitation in the UK, with greater acceptance of active treatment for infants <23 weeks’ gestation.</p> |
| first_indexed | 2024-03-06T18:39:32Z |
| format | Journal article |
| id | oxford-uuid:0c6ad0fc-f6e1-4e12-b42b-cd79f3c9c46b |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T18:39:32Z |
| publishDate | 2021 |
| publisher | BMJ Publishing Group |
| record_format | dspace |
| spelling | oxford-uuid:0c6ad0fc-f6e1-4e12-b42b-cd79f3c9c46b2022-03-26T09:34:51ZViability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionalsJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:0c6ad0fc-f6e1-4e12-b42b-cd79f3c9c46bEnglishSymplectic ElementsBMJ Publishing Group2021Di Stefano, LWood, KMactier, HBates, SWilkinson, D<p><strong>Background</strong> Decisions about treatments for extremely preterm infants (EPIs) born in the ‘grey zone’ of viability can be ethically complex. This 2020 survey aimed to determine views of UK neonatal staff about thresholds for treatment of EPIs given a recently revised national Framework for Practice from the British Association of Perinatal Medicine.</p> <p><strong>Methods</strong> The online survey requested participants indicate the lowest gestation at which they would be willing to offer active treatment and the highest gestation at which they would withhold active treatment of an EPI at parental request (their lower and upper thresholds). Relative risks were used to compare respondents’ views based on profession and neonatal unit designation. Further questions explored respondents’ conceptual understanding of viability.</p> <p><strong>Results</strong>336 respondents included 167 consultants, 127 registrars/fellows and 42 advanced neonatal nurse practitioners (ANNPs). Respondents reported a median grey zone for neonatal resuscitation between 22+1 and 24+0 weeks’ gestation. Registrars/fellows were more likely to select a lower threshold at 22+0 weeks compared with consultants (Relative Risk (RR)=1.37 (95% CI 1.07 to 1.74)) and ANNPs (RR=2.68 (95% CI 1.42 to 5.06)). Those working in neonatal intensive care units compared with other units were also more likely to offer active treatment at 22+0 weeks (RR=1.86 (95% CI 1.18 to 2.94)). Most participants understood a fetus/newborn to be ‘viable’ if it was possible to survive, regardless of disability, with medical interventions accessible to the treating team.</p> <p><strong>Conclusion</strong> Compared with previous studies, we found a shift in the reported lower threshold for resuscitation in the UK, with greater acceptance of active treatment for infants <23 weeks’ gestation.</p> |
| spellingShingle | Di Stefano, L Wood, K Mactier, H Bates, S Wilkinson, D Viability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionals |
| title | Viability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionals |
| title_full | Viability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionals |
| title_fullStr | Viability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionals |
| title_full_unstemmed | Viability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionals |
| title_short | Viability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionals |
| title_sort | viability and thresholds for treatment of extremely preterm infants survey of uk neonatal professionals |
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