Treatment choices for extremely preterm infants: An international perspective

Objective: To compare treatment choices of neonatal physicians and nurses i n 11 European countries for a hypothetical case of extreme prematurity (24 weeks' gestational age, birth weight of 560 g, Apgar score of 1 at 1 minute ). Study design: An anonymous, self-administered questionnaire was completed b y 1401 physicians (response rate, 89%) and 3425 nurses (response rate, 86%) From a Large, representative sample of 143 European neonatal intensive car e units. Italy, Spain, France, Germany: the Netherlands, Luxembourg, Great Britain, Sweden, Hungary, Estonia, and Lithuania participated. Results: Most physicians in every country but the Netherlands would resusci tate this baby and start intensive care. On subsequent deterioration of cli nical conditions caused by a severe intraventricular hemorrhage, attitudes diverge: most neonatologists in Germany, Italy Estonia, and Hungary would f avor continuation of intensive care, whereas in the other countries some fo rm of limitation of treatment would be the preferred choice. Parental wishe s appear to play a role especially in Great Britain and the Netherlands. Nu rses are more prone than doctors to withhold resuscitation in the delivery room and to ask parental opinion regarding subsequent treatment choices. Conclusion: An extremely premature infant is regarded as viable bq most phy sicians, whereas after deterioration of the clinical conditions decision-ma king patterns vary according to country. These findings have implications f or the ethical debate surrounding treatment of infants of borderline viabil ity and for the interpretation and comparison of international statistics.