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Title: Withdrawal and withholding of life sustaining treatment (wwlst): an under recognised factor in the morbidity or mortality of periviable infants? A narrative review.
Authors: Galloway I.;Roehr C.C.;Tan K. 
Monash Health Department(s): Paediatric - Neonatal (Monash Newborn)
Institution: (Galloway, Tan) Department of Paediatrics, School of Clinical Sciences, Monash University, Victoria, Australia
(Roehr) Women's and Children's, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
(Roehr) Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
(Roehr) National Perinatal Epidemiology Unit, Oxford Population Health, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
(Tan) Monash Newborn, Monash Children's Hospital, Victoria, Australia
(Tan) School of Medicine, Taylor's University, Selangor, Malaysia
Issue Date: 31-Mar-2024
Copyright year: 2024
Publisher: AME Publishing Company
Place of publication: Hong Kong
Publication information: Translational Pediatrics. 13(3) (pp 459-473), 2024. Date of Publication: March 2024.
Journal: Translational Pediatrics
Abstract: Background and Objective: The morbidity and mortality of infants born extremely preterm varies substantially across networks, within countries and throughout the globe. Most of the literature tends to focus on the management at birth and choices around active resuscitation of extremely preterm infants. Withdrawal and withholding of life sustaining treatment (WWLST) is an important and central process in the neonatal intensive care unit (NICU) and practices vary substantially. As such, our objective in this review was to explore whether end of life decisions also contribute to variations in the morbidity and mortality of periviable infants. Method(s): This narrative literature review is based on studies from the last 15 years found using several searches of medical databases (OVID Medline, Scopus and Cochrane Systematic Reviews) performed between March 2021 and December 2023. Key Content and Findings: Just as outcomes in periviable infants vary, the rates of and processes behind WWLST differ in the periviable population. Variation increases as gestational age decreases. Parental involvement is crucial to share decision making but the circumstances and rates of parental involvement differ. Strict guidelines in end-of-life care may not be appropriate, however there is a need for more targeted guidance for periviable infants as a specific population. The current literature available relating to periviable infants or WWLST is minimal, with many datasets rapidly becoming outdated. Conclusion(s): Further research is needed to establish the role of WWLST in variation of periviable infants' outcomes. The unification of data, acquisition of more recent datasets and inclusion of variables relating to end-of-life decisions in data collection will aid in this process.Copyright © 2024 AME Publishing Company. All rights reserved.
Type: Review
Subjects: gestational age
neonatal intensive care unit
newborn intensive careresuscitation
Type of Clinical Study or Trial: Review article (e.g. literature review, narrative review)
Appears in Collections:Articles

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