Between-Hospital Variation in Treatment and Outcomes in Extremely Preterm Infants

Abstract

BACKGROUND-Between-hospital variation in outcomes among extremely preterm infants is largely unexplained and may reflect differences in hospital practices regarding the initiation of active lifesaving treatment as compared with comfort care after birth.

Variability in the management and outcomes of extremely preterm births across five European countries: a population-based cohort study

“…In this group, survival rates appear to be determined partially by the implementation of management guidelines, as shown by corroborating studies 10 14. However, while survival rates were improved in this group for those with high levels of intervention, rates of survival free of severe morbidity were low.…”

“…The range of definitions of periviable birth has led to differences in the reported prevalence,9 and is likely to contribute to these wide international variations in reported survival rates 10. The definition of viability based on gestational age, birth weight and other factors may be influenced by variation in national legal registration criteria,11 12 and clinical guidelines overlaid by clinicians' perceived risk and parental opinions 13.…”

“…The definition of viability based on gestational age, birth weight and other factors may be influenced by variation in national legal registration criteria,11 12 and clinical guidelines overlaid by clinicians' perceived risk and parental opinions 13. This will also lead to variations in the initiation and continuation of intensive care10 and may impact on eligibility criteria for maternity and paternity benefits and funeral costs.…”

Delivery room practices for extremely preterm infants: the harms of the gestational age label

“…Treatment of neonates born at 22 and 23 weeks is clearly not futile: with interventions 20%–70% of such babies survive 3. No other treatment with such survival rates or long-term outcomes would be called futile.…”

End of life decisions for newborns: an ethical and compassionate process?

“…Perhaps variability should be expected as it is not uncommon in reports from large research collaborative. Recent evidence from the USA speaks of a similar variability across 24 different hospitals within the National Institute of Child Health and Human Development Neonatal Research Network,3 but the factors that contribute to the extent of variability require further inquiry. Is it institutional policy, fear of litigation, personal beliefs or something else?…”