Extremely premature infants, scarcity and the COVID‐19 pandemic

Issue highlights

“…Concerns have been raised that redistributing healthcare resources during the COVID‐19 pandemic may jeopardise the treatment of very preterm infants. Kaempf et al claim it could be misleading if obstetricians, neonatologists and ethicists blur legitimate issues of suboptimal health outcomes in extremely premature infants, resource consumption and authentic shared decision‐making with care rationing during the pandemic 6 . Haward et al disagree and express concerns that the COVID‐19 pandemic is being used as an excuse for the unjustifiable devaluation of the lives of preterm infants 7 …”

Using the COVID‐19 as an excuse for unjustified devaluation of preterm infants

“…Furthermore, discordance exists in quality‐of‐life assessments between providers, parents of disabled children and the disabled children themselves, reflecting our discipline's tendency towards ‘glass‐half‐empty’ sentiments 6,7 . Thus, combining composite outcomes of death with severe disability 1 unjustifiably equates the value of these outcomes.…”

“…Careful attention to the ‘principle findings’ in Kaempf et al’s 1 Table compared with their sources illustrates examples of broader provider bias. For instance, the authors omit mild disabilities (30%) when reporting on the entire sample, and they combine death with moderate and severe disability in their summary of gestational weeks from Serenius et al 4 Framed another way, the authors could have reported 2 out of 3 surviving infants of extremely premature gestations have mild or no disabilities, as Serenius et al concluded 4 .…”

“…Hospitals, institutions and regions have approached dilemmas differently, attempting as best they can to match needs of diverse patient populations in the midst of a pandemic. In their article, Extremely Premature Infants, Scarcity and the COVID‐19 Pandemic, Kaempf et al 1 suggest that the COVID‐19 pandemic has resulted in ‘obstetricians, neonatologists, and/or ethicists (to) blur legitimate extreme prematurity issues of suboptimal health outcomes, resource consumption, and authentic shared decision‐making with care’. We disagree and urge the authors to consider perspectives, highlighted by the pandemic, which help to clarify why many obstetricians, neonatologists and ethicists remain in support of providing extremely premature infants equal consideration in allocation algorithms with other patients 2 .…”

Should decision‐making for active resuscitation consider non‐communicable disease risks in periviable infants during the COVID‐19 pandemic?

“…One study reported survival with no, or mild, neurodevelopmental impairment in 64% and 76% of infants born at 22–23 weeks and 24–25 weeks, respectively 3 . Even Japan, which has pioneered the active management of infants born at 22 weeks, has not reported improvements in death rates or cognitive and neurodevelopmental outcomes in the last 10 years 4 …”