RT Journal Article
SR Electronic
T1 European variation in decision-making and parental involvement during preterm birth
JF Archives of Disease in Childhood - Fetal and Neonatal Edition
JO Arch Dis Child Fetal Neonatal Ed
FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
SP F245
OP F249
DO 10.1136/archdischild-2013-305191
VO 99
IS 3
A1 Katie Gallagher
A1 John Martin
A1 Matthias Keller
A1 Neil Marlow
YR 2014
UL http://fn.bmj.com/content/99/3/F245.abstract
AB 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