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European variation in decision-making and parental involvement during preterm birth
  1. Katie Gallagher1,
  2. John Martin2,
  3. Matthias Keller3,
  4. Neil Marlow4
  1. 1Florence Nightingale School of Nursing and Midwifery, King's College London, London, UK
  2. 2Department of Cardiovascular Science, University College London, London, UK
  3. 3Department of Paediatrics, Dritter Orden Children's Hospital, Passau, Germany
  4. 4Department of Neonatal Medicine, UCL Institute for Women's Health, London, UK
  1. Correspondence to Dr Katie Gallagher, Child and Adolescent Health, 1.36 JCMB, 57 Waterloo Road, King's College London SE10 9HB, UK; Katie.gallagher{at}kcl.ac.uk

Abstract

Background Preterm birth is a major global public health issue due to its prevalence, impact upon morbidity and mortality, and subsequent cost implications. Yet, policy analysis has not been undertaken to understand the different approaches across Europe to treatment decisions, and parental involvement in these decisions.

Methods A European survey and national guidance documentation analysis was undertaken with national neonatal or paediatric societies in Europe, exploring treatment decisions and parental involvement in decision-making for babies born at 22 to 25 completed weeks of gestation.

Results Responses were obtained from 19 European countries of 28 contacted. At 25 weeks of gestation there was universal initiation of active care at birth. At 24 weeks policy varied from initiating interventions (9), interventions dependent upon infant condition (8) and resuscitation restrictions (2). At 23 weeks and below, policy varied from no active intervention (7), individualised decision-making (8), parental permission required (3) and universal initiation of interventions (1). There were significant variations in the involvement of parents in the development of policy and in 16 countries the final decision regarding interventions rested with the attending doctor.

Implications There was little consensus as to how active intervention after birth at 22 to 25 weeks of gestation is managed, nor were parents included in the development of policy in many countries. At extremely low gestational ages, the criteria for or against active intervention at birth vary widely between different health systems in Europe

  • Neonatology
  • Resuscitation
  • Intensive Care
  • Health Service

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