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Acta Paediatr. 2019 Oct 20. doi: 10.1111/apa.15069. [Epub ahead of print]

Survey shows marked variations in approaches to redirection of care for critically ill very preterm infants in 11 countries.

Author information

1
Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Turku, Finland.
2
Department of Social Medicine, Neonatal Research Network Japan, National Center for Child Health and Development, Tokyo, Japan.
3
Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan.
4
Department of Paediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Canada.
5
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Toronto, Canada.
6
Department of Neonatal Medicine, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
7
Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel.
8
Department of Paediatrics, University of Otago, Christchurch, New Zealand.
9
Illinois Neonatal Network, Saint Louis, IL, USA.
10
Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
11
Department of Clinical Sciences/Pediatrics, Umeå University Hospital, Umeå, Sweden.
12
Division of Neonatology, National Center for Child Health and Development, Tokyo, Japan.
13
Neonatal Intensive Care Unit, Anna Meyer Children's University Hospital, Florence, Italy.
14
Department of Obstetrics and Gynecology and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
15
Division of Neonatology and Health Research Institute La Fe, Valencia, Spain.
16
Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, NSW, Australia.

Abstract

AIM:

We surveyed care practices for critically ill very preterm infants admitted to neonatal intensive care units (NICUs) in the International Network for Evaluating Outcomes in Neonates (iNeo) to identify differences relevant to outcome comparisons.

METHODS:

We conducted an online survey on care practices for critically ill very preterm infants and infants with severe intracranial haemorrhage (ICH). The survey was distributed in 2015 to representatives of 390 NICUs in 11 countries. Survey replies were compared with network incidence of death and severe ICH for infants born between 230/7 and 286/7  weeks of gestation from January 1, 2015, to December 31, 2015.

RESULTS:

Most units in Israel, Japan and Tuscany, Italy, favoured withholding care when care was considered futile, whereas most units in other networks favoured redirection of care. For infants with bilateral grade 4 ICH, redirection of care was very frequently (≥90% of cases) offered in the majority of units in Australia and New Zealand and Switzerland, but rarely in other networks. Networks where redirection of care was frequently offered for severe ICH had lower rates of survivors with severe ICH.

CONCLUSION:

We identified marked inter-network differences in care approaches that need to be considered when comparing outcomes.

KEYWORDS:

international survey; neonatal intensive care; redirection of care; severe intracranial haemorrhage; very preterm infant

PMID:
31630444
DOI:
10.1111/apa.15069

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