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Expanding the foundation for decisions on the treatment of extremely preterm infants

02.2024
Author Prof E. Harms, Münster University Children’s Hospital (Germany)

The decision to provide intensive care to periviable infants is an ethical dilemma. In Norway, guidelines state that life support is standard care from 25 weeks. However, in practice 97% of infants born at 24 weeks, 74% born at 23 weeks and 19% born at 22 weeks were transferred to a neonatal intensive care unit. The extent to which parents were involved in these decisions is not documented. In a Norwegian study, 80 paediatric residents participated in an anonymous survey after a compulsory training course in neonatology, where they were asked how they hypothetically would treat their own infant if born at 22–26 weeks. Only one participant would endorse life support for infants born at 22 or 23 weeks, 11 for infants born at 24 weeks, 47 for infants born at 25 weeks, and 63 for infants born at 26 weeks. The remaining participants responded with either “not sure” or “no”.

Comment: One can argue against this survey by pointing out that a person’s response to a hypothetical question does not necessarily correspond to their real-life actions. The discrepancy with the established practice in neonatal care underscores the challenges inherent to the grey area of medical decision-making. Decisions of this nature should align with the ethical and moral standards of society. Therefore, the authors advocate for involving not only the parents but also paediatricians with extensive experience in the care of premature infants, educators, and ethicists in the decision-making process.

Reference: 
[1] Syltern J, Markestad T. Norwegian paediatric residents surveyed on whether they would want life support for their own extremely preterm infant. Acta Paediatrica 2023; 112: 645–646.

 

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