Decision-making for extremely preterm infants with severe hemorrhages on head ultrasound: Science, values, and communication skills

Chevallier, Marie; Barrington, Keith J.; Church, Paige; Luu, Thuy Mai; Janvier, Annie

doi:10.1016/j.siny.2023.101444

Cited by 3 publications

(2 citation statements)

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“…However, as Chevallier et al points out, the outcomes due to intracranial haemorrhage are often uncertain and different depending on site, laterality, and subsequent neurological symptoms. Papile grading [a radiological grading system denoting the severity of intracranial haemorrhage from I (mild) to IV (severe)] ( 67 ) alone may not be an effective prognostication tool for making decisions about withdrawal of active treatment ( 68 ).…”

Section: Literature Reviewmentioning

confidence: 99%

“…This is important as framing statistics positively or negatively in perinatal counselling can affect parental decision making ( 83 , 84 ). Parental perspectives surrounding end of life care in the NICU have only recently stared to be explored ( 68 ). It seems only natural, then, that the extent of parental involvement in shared decision making about WWLST might also be a significant contributor to variation in outcomes.…”

Section: Literature Reviewmentioning

confidence: 99%

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Withdrawal and withholding of life sustaining treatment (WWLST): an under recognised factor in the morbidity or mortality of periviable infants?—a narrative review

Galloway,

Roehr,

Tan

2024

Transl Pediatr

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Background and Objective The morbidity and mortality of infants born extremely preterm varies substantially across networks, within countries and throughout the globe. Most of the literature tends to focus on the management at birth and choices around active resuscitation of extremely preterm infants. Withdrawal and withholding of life sustaining treatment (WWLST) is an important and central process in the neonatal intensive care unit (NICU) and practices vary substantially. As such, our objective in this review was to explore whether end of life decisions also contribute to variations in the morbidity and mortality of periviable infants. Methods This narrative literature review is based on studies from the last 15 years found using several searches of medical databases (OVID Medline, Scopus and Cochrane Systematic Reviews) performed between March 2021 and December 2023. Key Content and Findings Just as outcomes in periviable infants vary, the rates of and processes behind WWLST differ in the periviable population. Variation increases as gestational age decreases. Parental involvement is crucial to share decision making but the circumstances and rates of parental involvement differ. Strict guidelines in end-of-life care may not be appropriate, however there is a need for more targeted guidance for periviable infants as a specific population. The current literature available relating to periviable infants or WWLST is minimal, with many datasets rapidly becoming outdated. Conclusions Further research is needed to establish the role of WWLST in variation of periviable infants’ outcomes. The unification of data, acquisition of more recent datasets and inclusion of variables relating to end-of-life decisions in data collection will aid in this process.

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Section: Literature Reviewmentioning

confidence: 99%