Preterm birth treatment guidelines vary in Europe

By Rob Goodier

NEW YORK (Reuters Health) - Guidelines vary widely among European countries for managing active treatment of babies born extremely preterm, a new survey has found.

In 19 countries evaluated there was little agreement on how to treat babies born after 22 to 25 weeks of gestation, and parents were not usually included in policymaking decisions, according to the research.

"Each country tends to make up its own mind as to how to manage babies at extremely low gestations," senior author Dr. Neil Marlow, of the UCL EGA Institute for Women's Health in London, told Reuters Health by email.

"The problem is that it is against an ever improving background of survival, but less certain improvements in the rates of impairment and the degree to which this impacts individual decisions. Thus different countries come to different decisions using the same data," Dr. Marlow said.

Dr. Marlow and his team published their findings online February 19 in Archives of Disease in Childhood - Fetal and Neonatal Edition.

Data from surveys of national pediatric and neonatal societies in 19 countries showed the most agreement in guidelines for babies born at 25 weeks of gestation. Sixteen countries call for resuscitation and three recommend intervention based on the baby's condition.

For babies born at 24 weeks, nine countries call for resuscitation at birth, eight call for condition-based intervention, and two countries restrict resuscitation, calling for no cardiac compressions or drugs.

For babies born at 23 weeks and earlier, seven countries call for no active intervention, eight for decisions made on a case-by-case basis, three for parental permission, and one for immediate intervention. Twelve of the 19 countries include parents in the decision to resuscitate when the child is born at 23 weeks or earlier.

The doctor has the final say on resuscitation in 16 countries, and not a single one of the countries evaluated gives the final say to the parents. Doctors and parents decide together in two countries and the High Court decides in the final country.

Only three countries consulted with parents when setting their policy. That failure to include parents could lead to policy based less on evidence and more on doctors' opinions, Dr. Marlow said.

"We have no plans to suggest a European fix for this, but we hope it will highlight the great differences between countries and lead to wider informed debate. In particular, we want the prospective parent's voice heard in these discussions as it is all too easy for doctors to decide based on data that they have based on their own preferences," he said.

SOURCE: http://bit.ly/1fMZrhw

Arch Dis Child Fetal Neonatal Ed 2014.

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