Background and aims In the updated (2010) Dutch national guideline “perinatal practice in extremely premature delivery”, the gestational age (GA) at which resuscitation can be offered was lowered from 25+0 weeks to 24+0 weeks. Informed consent of the parents is required, however adequate prenatal counselling is not defined. We aimed to invent current and ideal counselling practice amongst professionals.
Methods Online questionnaire regarding current and ideal prenatal counselling (expected GA 24+0 weeks), completed by neonatologists and obstetricians from all tertiary centres in the Netherlands.
Results 120 questionnaires were returned (response rate 60%). Almost everybody (93%1 vs 98%2) agreed with shared-decision making as an ideal model for counselling parents whether or not to initiate active care. A majority prefers recommendation of active care at 24 weeks GA, but comfort care on parental request is acceptable (58%1 vs 49%2). A minority prefers recommendation of comfort care and active care only on parental request (11%1 vs 23%2). Current factors making it less likely to recommend active care at 24 weeks GA: dysmaturity (92%1 vs 76%2) and additional congenital anomalies (99%1 vs 98%2).
There were differences in the preferential GA for certain interventions, the majority (58%) of neonatologists mentions chest compressions are justified above 26+0 weeks GA and 28.3% above 25+0 weeks GA. Obstetricians give earlier marges: either above 25+0 weeks GA (40%) or above 24+0 weeks GA (40%).
Conclusions We observed only partial consensus on current and ideal prenatal counselling. Further discussion ideally results in a consensus-based guideline.
1 = neonatologists 2 = obstetricians.