B Lemyre1, T Daboval1, S Dunn2,3, M Kekewich4, G Jones1, D Wang1, M Mason-Ward5, G P Moore1. 1. Division of Neonatology, Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Canada. 2. CHEO Research Institute, Ottawa, Canada. 3. Better Outcomes Registry & Network (BORN), Ottawa, Canada. 4. Department of Clinical and Organizational Ethics, The Ottawa Hospital, Ottawa, Canada. 5. Champlain Maternal Newborn Regional Program, Ottawa, Canada.
Abstract
OBJECTIVE: Making prenatal decisions regarding resuscitation of extremely premature infants, based on gestational age alone is inadequate. We developed a prognosis-based guideline. STUDY DESIGN: We followed a five step approach and used the AGREE II framework: (1) systematic review and critical appraisal of published guidelines; (2) identification of key medical factors for decision making; (3) systematic reviews; (4) creation of a multi-disciplinary working group and (5) external consultation and appraisal. RESULT: No published guideline met high-quality appraisal criteria. Survival, neurodevelopmental disability, quality of life of child and parents, and maternal mortality and risk of long-term morbidity were identified as key for quality decision-making. Eighteen stakeholders (including parents) advocated for the incorporation of parents' values and preferences in the process. CONCLUSION: A novel framework, based on prognosis, was generated to guide when early intensive and palliative care may both be offered to expectant parents. Pre-implementation assessment is underway to identify barriers and facilitators to putting in practice.
OBJECTIVE: Making prenatal decisions regarding resuscitation of extremely premature infants, based on gestational age alone is inadequate. We developed a prognosis-based guideline. STUDY DESIGN: We followed a five step approach and used the AGREE II framework: (1) systematic review and critical appraisal of published guidelines; (2) identification of key medical factors for decision making; (3) systematic reviews; (4) creation of a multi-disciplinary working group and (5) external consultation and appraisal. RESULT: No published guideline met high-quality appraisal criteria. Survival, neurodevelopmental disability, quality of life of child and parents, and maternal mortality and risk of long-term morbidity were identified as key for quality decision-making. Eighteen stakeholders (including parents) advocated for the incorporation of parents' values and preferences in the process. CONCLUSION: A novel framework, based on prognosis, was generated to guide when early intensive and palliative care may both be offered to expectant parents. Pre-implementation assessment is underway to identify barriers and facilitators to putting in practice.
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