The new AAP position statement concerning extremely preterm birth decision making. A great leap… sideways.

There’s this important set of guidelines on antenatal counseling of parents when a baby is expected to be born before 25 weeks of gestation have been completed. I’ve been traveling and haven’t had time to really think this through. But, this post on the Neonatal Research blog does examine some of the important issues.

Neonatal Research

To me, this new ‘clinical report’ was a major disappointment.

Even though there are some good parts to this statement, there is one huge, major failing: there is absolutely no evidence that parents were consulted or included in the process of statement development. In 2015 how can you possibly release a clinical practice guideline like this and not involve families?

As for the substance of the ‘clinical report’ there is good along with the less good.

First the good, the report goes into some detail about the limitations of gestational age assessment, and the limitations of gestational age as a prognostic factor. The discussion of these limitations is quite well done in general.

There is also a clear statement that decision making based on clinical evaluation in the delivery room is inappropriate.

It is recommended, therefore, that decisions regarding resuscitation be well communicated and agreed on before the birth, if possible…

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