Dutch guidelines on care for extremely premature infants: Navigating between personalisation and standardization

Objective: There is no international consensus on what type of guideline is preferred for care at the limit of viability. We aimed to conceptualize what type of guideline is preferred by Dutch healthcare professionals: 1) none; 2) gestational-age-based; 3) gestational-age based-plus; or 4) prognosis-based via a survey instrument. Additional questions were asked to explore the grey zone and attitudes towards treatment variation. Finding: 769 surveys were received. Most of the respondents (72.8%) preferred a gestational age-based-plus guideline. Around 50% preferred 24(+0/7) weeks gestational age as the lower limit of the grey zone, whereas 26(+0/7) weeks was the most preferred upper limit. Professionals considered treatment variation acceptable when it is based upon parental values, but unacceptable when it is based upon the hospital's policy or the physician's opinion. Conclusion: In contrast to the current Dutch guideline, our results suggest that there is a preference to take into account individual factors besides gestational age. (c) 2021 The Author(s). Published by Elsevier Inc.

Automated summary

Contrary to the current Dutch guideline, healthcare professionals in the Netherlands showed a preference for guidelines that take into account individual factors in addition to gestational age. Their preferred guideline is gestational-age-based-plus. The study also found that treatment variation is considered acceptable when it is based on parental values, but unacceptable when it is based on the hospital's policy or the physician's opinion.