Aims There are Nuffield Guidelines in place to aid clinicians in their decision-making in the resuscitation of extreme preterm infants. This remains an area where there is varied practice nationally and internationally, and decisions are often case dependant. We sought to survey a cohort of Consultant Paediatricians involved in neonatal resuscitation on their approach to the resuscitation of extreme preterm infants, to assess current attitudes to practice.
Methods A questionnaire was designed using an online survey programme, modelled on the Nuffield guidance for resuscitation of extreme preterm infants. This was distributed to a group of Consultants via email and results were collated using the online programme.
Results 45 of 68 (66%) Consultants completed the survey. 26% of responders were from level 3 neonatal intensive care units (NICU), 62% from level 2 units and 12% from level 1 units. 91% of responders would always offer intensive care with the intention of admitting to NICU at 25 weeks gestation and above, compared to 58% at 24 weeks and 6.8% at 23 weeks gestation. At 24 weeks, 38% of responders would make the decision of whether to resuscitate based on the infant’s initial clinical condition compared to 61% at 23 weeks. For 23 weeks gestation infants, giving precedence to parents’ wishes (57%) and weighing the baby before commencing resuscitation (32%) were highest. At 22 weeks, 58% of responders would not resuscitate and 29% would not attend the delivery.
Conclusion There were varied responses at every gestation. Whilst the majority of 25 week and above gestation infants are offered full intensive care in accordance with Nuffield guidance, this was not the case for 24 week gestation infants. Initial clinical condition and response to initial resuscitation at birth play a larger role in decision making at 23 and 24 weeks. Parents’ wishes and birthweight are more significant factors in decision making at 23 weeks. The varying attitudes to practice at each gestation highlight the challenges in following guidelines in the resuscitation of extreme preterm infants. This calls into question whether there is a need for more consensus.
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