ArticlePediatrics2018
Thresholds for Resuscitation of Extremely Preterm Infants in the UK, Sweden, and Netherlands.
Article in Pediatrics, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
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Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 59 citations in OpenAlex.
- Part 3: Ethics: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.Circulation · 2025Guideline
- Are guidelines needed? International perspectives on decision-making and practice variation in the care of extremely preterm infants.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- From "can we treat?" to "should we treat?": a narrative review on resuscitation limits at the threshold of viability.European journal of pediatrics · 2026Review
- Outcomes of Preterm Infants Born at 22 to 23 Weeks' Gestation in 11 International Neonatal Networks.JAMA pediatrics · 2025Article
- Debate: Should Parents be able to Request Non-Resuscitation for All Extremely Premature Newborn Infants?Asian bioethics review · 2025Article
- Ethical considerations regarding the treatment of extremely preterm infants at the limit of viability: a comprehensive review.European journal of pediatrics · 2025Review
- Article
- Need for national guidance regarding proactive care of infants born at 22-23 weeks' gestation.Clinical and experimental pediatrics · 2025Article
- Neonatal Training across Union of European Medical Specialists Member Countries: A Survey from the Next Generation of Neonatologists.Neonatology · 2025Article
- Withdrawal and withholding of life sustaining treatment (WWLST): an under recognised factor in the morbidity or mortality of periviable infants?-a narrative review.Translational pediatrics · 2024Review
- Public Attitudes Toward Ethics and Practices in End-of-Life Decision-Making for Neonates.JAMA network open · 2024Article
- Scandinavian perspectives on life support at the border of viability.Frontiers in pediatrics · 2024Review
- Opportunities and Challenges of Prognostic Models for Extremely Preterm Infants.Children (Basel, Switzerland) · 2023Article
- Determining resuscitation threshold for extremely preterm infants based on the survival rates without severe neurological injury.Journal of global health · 2023Article
- Global Policy and Practice for Intrauterine Fetal Resuscitation During Fetal Surgery for Open Spina Bifida Repair.JAMA network open · 2023Article
- Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative study.BMC pediatrics · 2023Article
- Effect of national guidance on survival for babies born at 22 weeks' gestation in England and Wales: population based cohort study.BMJ medicine · 2023Article
- Obstetricians' Attitudes Toward the Treatment of Extremely Preterm Infants in China.JAMA network open · 2022Article
- Viability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionals.Archives of disease in childhood. Fetal and neonatal edition · 2021Article
- The limits of small-for-gestational-age as a high-risk category.European journal of epidemiology · 2021Article
Corrections and comments
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Authors and funding
3 authors at 3 institutions in 3 countries.
Funding
Abstract
backgroundIt is widely acceptable to involve parents in decision-making about the resuscitation of extremely preterm infants (EPIs) in the gray zone. However, there are different views about where the boundaries of the gray zone should lie. Our aim in this study was to compare the resuscitation thresholds for EPIs between neonatologists in the United Kingdom, Sweden, and the Netherlands.
methodsWe distributed an online survey to consultant neonatologists and neonatal registrars and fellows that included clinical scenarios in which parents requested resuscitation or nonresuscitation. Respondents were asked about the lowest gestational age and/or the worst prognosis at which they would provide resuscitation and the highest gestational age and/or the best prognosis at which they would withhold resuscitation. In additional scenarios, influence of the condition at birth or consideration of available health care resources was assessed.
resultsThe survey was completed by 162 neonatologists (30% response rate). There was a significant difference between countries; the gray zone for most UK respondents was 23 + 0/7 to 23 + 6/7 or 24 weeks' gestation, compared with 22 + 0/7 to 22 + 6/7 or 23 weeks' gestation in Sweden and 24 + 0/7 to 25 + 6/7 or 26 weeks' gestation in the Netherlands. Resuscitation thresholds were higher if an infant was born in poor condition. There was wide variation in the prognosis that warranted resuscitation or nonresuscitation. Consideration of resource scarcity did not alter responses.
conclusionsIn this survey, we found significant differences in approach to the resuscitation of EPIs, with a spectrum from most proactive (Sweden) to least proactive (Netherlands). Most survey respondents indicated shifts in decision-making that were associated with particular weeks' gestation. Despite the different approaches to decision-making in the 3 countries, there was relatively little difference between countries in neonatologists' prognostic thresholds for resuscitation.
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