1. End-of-life decisions and practices for very preterm infants in the Wallonia-Brussels Federation of Belgium
- Author
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Aujoulat, Isabelle, Henrard, Sévérine, Charon, Anne, Johansson, Anne Britt, Langhendries, Jean-Paul, Mostaert, Anne, Vermeylen, Danièle, Verellen, Gaston, Maton, Pierre, Van Overmeire, Bart, Kalenga, Masendu, Broux, Isabelle, Henrion, Elisabeth, Dussart, Anneliese, Muller, Marie-Françoise, Cavatorta, Eric, Maréchal, Yoann, Vanden Eijnden, Serge, Lecart, Chantal, Haumont, Dominique, Van Herreweghe, Inge, Vlieghe, Vinciane, Debauche, Christian, Flausch, Marc, Sepulchre, Brigitte, and UCL - SSS/IRSS - Institut de recherche santé et société
- Subjects
Male ,Parents ,Palliative care ,Computer-assisted web interviewing ,Pediatrics ,0302 clinical medicine ,Belgium ,Neonatologists ,Surveys and Questionnaires ,030212 general & internal medicine ,Practice Patterns, Physicians' ,Survey ,Terminal Care ,lcsh:RJ1-570 ,Uncertainty ,Middle Aged ,Perinatology ,and Child Health ,Perinatal Care ,Infant, Extremely Premature ,Female ,Research Article ,NICU ,Adult ,medicine.medical_specialty ,Attitude of Health Personnel ,Pédiatrie ,Best practice ,Clinical Decision-Making ,Decision Making ,Gestational Age ,03 medical and health sciences ,030225 pediatrics ,Intensive care ,Intensive Care Units, Neonatal ,medicine ,Very Preterm Birth ,Humans ,business.industry ,Public health ,Infant, Newborn ,lcsh:Pediatrics ,Preterm birth ,Withholding Treatment ,Family medicine ,Pediatrics, Perinatology and Child Health ,Ethical dilemma ,business ,Qualitative research ,End-of-life - Abstract
Background: Very preterm birth (24 to < 32 week's gestation) is a major public health issue due to its prevalence, the clinical and ethical questions it raises and the associated costs. It raises two major clinical and ethical dilemma: (i) during the perinatal period, whether or not to actively manage a baby born very prematurely and (ii) during the postnatal period, whether or not to continue a curative treatment plan initiated at birth. The Wallonia-Brussels Federation in Belgium counts 11 neonatal intensive care units. Methods: An inventory of key practices was compiled on the basis of an online questionnaire that was sent to the 65 neonatologists working in these units. The questionnaire investigated care-related decisions and practices during the antenatal, perinatal and postnatal periods, as well as personal opinions on the possibility of standardising and/or legislating for end-of-life decisions and practices. The participation rate was 89% (n = 58). Results: The results show a high level of homogeneity pointing to overall agreement on the main principles governing curative practice and the gestational age that can be actively managed given the current state of knowledge. There was, however, greater diversity regarding principles governing the transition to end-of-life care, as well as opinions about the need for a common protocol or law to govern such practices. Conclusion: Our results reflect the uncertainty inherent in the complex and diverse situations that are encountered in this extreme area of clinical practice, and call for qualitative research and expert debates to further document and make recommendations for best practices regarding several "gray zones" of end-of-life care in neonatology, so that high quality palliative care may be granted to all neonates concerned with end-of-life decisions., SCOPUS: ar.j, info:eu-repo/semantics/published
- Published
- 2018