ArticlePloS one2025
Healthcare professionals interpersonal variability and determinants of medical decision thresholds for active management of extremely preterm infants in a level 3 perinatal center in France.
Article in PloS one, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
1 citing paper in PubMed.
- Changes in the Incidence and Severity of NEC over the Last Decade: A Single-Center Study.Journal of clinical medicine · 2025Article
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6 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundBefore 26 weeks of gestational age, because extremely preterm infants (EPI) face a high risk of death or disability, management decisions may involve either active treatment or palliative care. Survival chances largely depend on the willingness of medical teams and parents to opt for active management. Variability of practices explains differences in survival between countries and regions, and interpersonal variability may also exist among caregivers within the same center. Our objective was to study the variability of management decisions and their determinants among caregivers in a French type 3 maternity hospital.
methodsAll caregivers, obstetricians, pediatricians, and midwives, involved in the management of EPI in a type 3 perinatal center were surveyed using a self-administered questionnaire. Each respondent reported their personal thresholds for deciding on active management, defined as the unborn child's estimated likelihood of survival without severe neonatal morbidity. Median and interquartile ranges (IQR) of these thresholds were calculated and compared by respondent characteristics.
results85 (75%) eligible professionals responded. The median threshold of survival without severe neonatal morbidity below which active management was deemed impossible was 15% (IQR 10-30%), while the median threshold above which active management could not be refused was 80% (IQR 70-90%). Wide IQRs indicated significant variability in individual thresholds. This variability appeared to be influenced by profession and gender but was not associated with factors such as having children, age, experience, or the personal estimates of the neonates' outcomes.
conclusionsDecision thresholds for active management of EPI, expressed in terms of survival without severe neonatal morbidity, vary significantly among professionals. The thresholds reported in our study were notably higher than those observed in other countries, which may help explain the lower rates of active management before 26 weeks in France. Recognizing these differences and comparing personal thresholds with peers could facilitate more consensus-based decision-making within teams.
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