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5. End-of-life decisions and practices for very preterm infants in the Wallonia-Brussels Federation of Belgium

Author

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

6. Systemic hydrocortisone to prevent bronchopulmonary dysplasia in preterm infants (the SToP-BPD study); a multicenter randomized placebo controlled trial

Author

Onland Wes, Offringa Martin, Cools Filip, De Jaegere Anne P, Rademaker Karin, Blom Henry, Cavatorta Eric, Debeer Anne, Dijk Peter H, van Heijst Arno F, Kramer Boris W, Kroon Andre A, Mohns Thilo, van Straaten Henrica L, te Pas Arjan B, Theyskens Claire, van Weissenbruch Mirjam M, and van Kaam Anton H

Subjects
Pediatrics, RJ1-570
Abstract

Abstract Background Randomized controlled trials have shown that treatment of chronically ventilated preterm infants after the first week of life with dexamethasone reduces the incidence of the combined outcome death or bronchopulmonary dysplasia (BPD). However, there are concerns that dexamethasone may increase the risk of adverse neurodevelopmental outcome. Hydrocortisone has been suggested as an alternative therapy. So far no randomized controlled trial has investigated its efficacy when administered after the first week of life to ventilated preterm infants. Methods/Design The SToP-BPD trial is a randomized double blind placebo controlled multicenter study including 400 very low birth weight infants (gestational age < 30 weeks and/or birth weight < 1250 grams), who are ventilator dependent at a postnatal age of 7 - 14 days. Hydrocortisone (cumulative dose 72.5 mg/kg) or placebo is administered during a 22 day tapering schedule. Primary outcome measure is the combined outcome mortality or BPD at 36 weeks postmenstrual age. Secondary outcomes are short term effects on the pulmonary condition, adverse effects during hospitalization, and long-term neurodevelopmental sequelae assessed at 2 years corrected gestational age. Analysis will be on an intention to treat basis. Discussion This trial will determine the efficacy and safety of postnatal hydrocortisone administration at a moderately early postnatal onset compared to placebo for the reduction of the combined outcome mortality and BPD at 36 weeks postmenstrual age in ventilator dependent preterm infants. Trial registration number Netherlands Trial Register (NTR): NTR2768

Published
2011
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