When should intensive care be provided for the extremely preterm infants born at the margin of viability? A survey of Australasian parents and clinicians. (17th August 2020)

• Record Type: Journal Article
• Authors: Tan, Alvin H K; Shand, Antonia W; Marsney, Renate L; Schindler, Timothy; Bolisetty, Srinivas; Guaran, Robert; Cruz, Melinda; Chow, Sharon S W; Lui, Kei
• Is Part Of: Journal of paediatrics and child health. Volume 57:Number 1(2021)
• Page Start: 52
• Page End: 57
• Publication Date: 2020-08-17
• Subjects: extreme prematurity -- intensive care -- mortality and major disability -- resuscitation; Children -- Health and hygiene -- Periodicals; Pediatrics -- Periodicals; 618.92
• DOI: 10.1111/jpc.15115
• Languages: English
• ISSNs: 1034-4810

Abstract

Abstract : Aim: This study aimed to explore clinician and parent opinions of risk limits on resuscitation and intensive care (IC) for extremely premature infants born at the margin of viability. Methods: Two anonymous on‐line surveys were conducted from August 2016 to January 2017. Survey participants were: (i) clinicians affiliated with neonatal intensive care units in Australia; and (ii) parents or individuals who expressed interest in premature babies through the Facebook page of Miracle Babies Foundation. Results: A total of 961 responses were received. Among 204 clinicians, 52% were neonatologists, 22% obstetricians, 20% neonatal intensive care unit nurses and 4% were midwives. Among 757 parents, 98% had a premature baby. Only 75% of clinicians responded to the risk limits questions. Median mortality risk above which they would not recommend resuscitation/IC was 70% (interquartile range (IQR) 50–80%); major disability risk in survivors 60% (IQR 50–75%); and composite risk of mortality and major disability 70% (IQR 50–80%). All parents answered the risk limit questions. The median mortality risk for not planning resuscitation was 90% (IQR 60–90%); major disability risk in survivors 50% (IQR 30–90%); and composite risk 90% (IQR 50–90%). Most clinicians (82%) stated that decisions should be guided by parent opinions if there are uncertainties. Parents had varying perception of previous counselling, and 57% stated that both their viewpoint and doctor's predicted risk influenced their decision‐making. Conclusions: Clinicians and parents had different views on mortality and major disability risks when deciding on resuscitation/neonatal IC treatment. When there was uncertainty, both agreed on working together.