Abstract
BackgroundSince 2010, intensive care can be offered in the Netherlands at 24+0 weeks gestation (with parental consent) but the Dutch guideline lacks recommendations on organization, content and preferred decision-making of the counselling. Our aim is to explore preferred prenatal counselling at the limits of viability by Dutch perinatal professionals and compare this to current care.MethodsOnline nationwide survey as part of the PreCo study (2013) amongst obstetricians and neonatologists in all Dutch level III perinatal care centers (n = 205).The survey regarded prenatal counselling at the limits of viability and focused on the domains of organization, content and decision-making in both current and preferred practice.ResultsOne hundred twenty-two surveys were returned out of 205 eligible professionals (response rate 60%). Organization-wise: more than 80% of all professionals preferred (but currently missed) having protocols for several aspects of counselling, joint counselling by both neonatologist and obstetrician, and the use of supportive materials. Most professionals preferred using national or local data (70%) on outcome statistics for the counselling content, in contrast to the international statistics currently used (74%). Current decisions on initiation care were mostly made together (in 99% parents and doctor). This shared decision model was preferred by 95% of the professionals.ConclusionsDutch perinatal professionals would prefer more protocolized counselling, joint counselling, supportive material and local outcome statistics. Further studies on both barriers to perform adequate counselling, as well as on Dutch outcome statistics and parents’ opinions are needed in order to develop a national framework.Trial registrationClinicaltrials.gov, NCT02782650, retrospectively registered May 2016.
Highlights
Since 2010, intensive care can be offered in the Netherlands at 24+0 weeks gestation but the Dutch guideline lacks recommendations on organization, content and preferred decision-making of the counselling
Just as some international guidelines which include a role for parents the Dutch guideline explicitly requires informed consent of parents when initiating intensive care at 24 weeks gestational ages (GA)
The primary aim of this study is to explore preferences amongst Dutch perinatal professionals on prenatal counselling at the limits of viability on three domains: organization, content, and decision-makingprocess
Summary
Since 2010, intensive care can be offered in the Netherlands at 24+0 weeks gestation (with parental consent) but the Dutch guideline lacks recommendations on organization, content and preferred decision-making of the counselling. The anticipated delivery of an extremely premature infant at the limits of viability confronts parents as well as perinatal professionals with medical, ethical and emotional issues; especially when a decision on the initiation of care has to be made. Some guidelines on resuscitation at the limits of viability have included recommendations on the parental involvement in the decision-making process. In 2010, the Dutch guideline on perinatal practice in extremely premature delivery lowered the limit offering intensive care from 25+0 to 24+0 weeks GA. Just as some international guidelines which include a role for parents the Dutch guideline explicitly requires informed consent of parents when initiating intensive care at 24 weeks GA
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