Decision-making around resuscitation of extremely preterm infants in the Philippines: A consensus guideline

Abstract

While the vast majority of preterm births globally occur in low- and middle-income countries, existing published guidelines relating to the decision-making and resuscitation of extremely preterm infants (EPIs) largely focus on high-income countries. In 2018-2019, a working group of the Philippine Society of Newborn Medicine aimed to develop the first national guideline relating to the care of EPIs. The working group reviewed data on the outcomes of EPIs in the Philippines, surveyed paediatricians and neonatologists in the Philippines about current practice and held a consensus workshop. This paper describes the guideline development process and presents a summary of the guidelines. The national guidelines endorse consistency in decision-making. Health professionals should take into consideration the views and wishes of the infant's parents and the availability of resources to treat the newborn infant. Active management would be appropriate to provide for potentially viable preterm infants at moderate to high risk of poor outcomes, where parents have expressed their wish for this management (and where there are resources available to provide this treatment). For such infants, where parents have expressed their wish to withhold active management, palliative management would also be appropriate to provide. The guideline endorses a grey zone for neonatal resuscitation from approximately 24 to 28 weeks' gestation in the Philippines, reflecting the context for resuscitation in low- and middle-income countries. Disparities in resource availability are themselves an ethical concern for neonatologists and should be a stimulus for advocacy and improvements in health-care delivery.

Keywords: Philippines; clinical decision-making; consensus development conference; infant, extremely premature; practice guideline; resuscitation.

Figure 1

Preterm mortality according to gestational age at the Philippine General Hospital, Manila, 2014–2018. (), ≤25 weeks; (), 26 weeks; (), 27 weeks; (), 28 weeks; (), 29 weeks; (), 30 weeks; (), 31 weeks; (), 32 weeks.

Figure 2

Frequency of initiating resuscitation for a given gestational age as reported in 2018. (), Never; (), rarely; (), sometimes; (), often; (), always. (Reproduced from Hayden et al.,24 with permission).

Figure 3

Multi‐variable model for the assessment of risk for the extremely preterm infant in the Philippines. NICU, neonatal intensive care unit.