Article Text

RESUSCITATION AT THE LIMITS OF VIABILITY: AN IRISH PERSPECTIVE
  1. R A Khan1,
  2. M P O Connell2,
  3. E M Dempsey3
  1. 1Department of Neonatology, Coombe Women and Infant University Hospital, Dublin, Ireland
  2. 2Department of Obstetrics and Gynaecology, Coombe Women and Infant University Hospital, Dublin, Ireland
  3. 3Department of Neonatology, Cork University Maternity Hospital, Cork, Ireland

Abstract

Background Advances in neonatal care continue to lower the limit of viability. Decision-making is now more challenging and outcome may be perceived differently.

Objective To explore the opinions of healthcare providers on resuscitation and outcome in less than 28 week newborns.

Methods An anonymous questionnaire was sent to various working healthcare providers in Ireland. Questions related to early management of the less than 28 weeks infant and estimated survival and long-term outcome.

Results Response rate was 55%. 80% were roman catholic. 40% responders have more than 10 years experience. 50% of respondents work in a level 3 setting. Less than 1% and 10% would advocate resuscitation at 22 weeks and 23 weeks gestation, respectively. 80% of all healthcare providers would resuscitate at 24 weeks gestation. The duration of resuscitataion efforts differed across gestational age groups and between different healthcare groups. 20% of all healthcare providers would advocate the cessation of resuscitation efforts on 22–25 weeks gestation at 5 minutes of age if there was no response. The majority of neonatologists and specialist registrars in paediatrics would cease resuscitation at 10 minutes of age if no response to resuscitation. Wide variation in survival and long-term survival estimates was identified between different healthcare provider groups. Neonatal nurses are more optimistic about outcome than midwives. Obstetricians were more pessimistic about survival and long-term outcome in newborns delivered between 24 and 27 weeks when compared with neonatologists.

Conclusions Neonatologists, trainees in paediatrics and neonatal nurses are generally more optimistic about outcome than their counterparts in obstetric care. This is reflected in a greater willingness to provide resuscitation efforts in the grey zone (less than 25 weeks).

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