Marina Cuttini

Caesarean section on request: a comparison of obstetricians' attitudes in eight European countries

Objective  To explore the attitudes of obstetricians to performe a caesarean section on maternal request in the absence of medical indication.

Withholding/withdrawing treatment from neonates: legislation and official guidelines across Europe.

Representatives from eight European countries compared the legal, ethical and professional settings within which decision making for neonates takes place. When it comes to limiting treatment there is general agreement across all countries that overly aggressive treatment is to be discouraged. Nevertheless, strong emphasis has been placed on the need for compassionate care even where cure is not possible. Where a child will die irrespective of medical intervention, there is widespread acceptance of the practice of limiting aggressive treatment or alleviating suffering even if death may be hastened as a result. Where the infant could be saved but the future outlook is bleak there is more debate, but only two countries have tested the courts with such cases. When it comes to the active intentional ending of life, the legal position is standard across Europe; it is prohibited. However, recognising those intractable situations where death may be lingering and unpleasant, Dutch paediatricians have reported that they do sometimes assist babies to die with parental consent. Two cases have been tried through the courts and recent official recommendations have set out standards by which such actions may be assessed.

Do Healthy Preterm Children Need Neuropsychological Follow-Up? Preschool Outcomes Compared with Term Peers.

Aim  The aim of this study was to determine neuropsychological performance (possibly predictive of academic difficulties) and its relationship with cognitive development and maternal education in healthy preterm children of preschool age and age‐matched comparison children born at term.

PO-0816 Temperament In Very Preterm Infants At 2-years Corrected Age: Validation Of The Infant Characteristic Questionnaire In The Italian Action Cohort

Background and aims Temperament in very preterm infants (VPI) has been rarely studied. We used a short version of the Bates Infant Characteristic Questionnaire (ICQ) to explore maternal reported child difficultness in an area-based cohort of Italian VPI. Methods Study population included 1196 infants (response rate 85%). A medical examination was carried out to assess infants’ health and presence of disabilities. A postal maternal questionnaire was used to measure development and temperament. We used the sections corresponding to ‘Fussy-difficult’ and ‘Unadaptable’, with 12 items rated on a 7-point Likert-type scale. Higher scores indicate more problematic temperament. Statistical analysis included factor analysis and calculation of Cronbach alpha. To assess validity, comparisons with sleep and eating problems reported by mothers independently from ICQ were carried out. Results For this study only singletons born from Italian mothers were considered (n. 586); 55% were males, and 21% were below 28 weeks gestation. Forty infants (7%) had at least one severe disability. Mean ICQ score was 34.1 (SD 10.1), and median 33 (range 13–69). Factor loadings were comparable to the original English version, and internal consistency was satisfactory (alpha 0.88 for fussy-difficult and 0.71 for Unadaptable). Infants with difficulties getting to sleep, frequent night awakenings, and ‘picky eaters’ had significantly higher ICQ scores (p values <0.01). Conclusion The short version of the ICQ may represent a quick and easily administered tool for the identification of difficult temperament traits in clinical and research settings. Acknowledgements Action follow-up study was funded by Italian MoH and Chiesi Spa.

Attitudes of Swedish midwives towards management of extremely preterm labour and birth

OBJECTIVE the aim of the study was to ascertain the attitudes of Swedish midwives towards management of very preterm labour and birth and to compare the attitudes of midwives at university hospitals with those at general hospitals. DESIGN this cross-sectional descriptive and comparative study used an anonymous self-administrated questionnaire for data collection. Descriptive and analytic statistics were carried out for analysis. PARTICIPANTS the answers from midwives (n=259) were collected in a prospective SWEMID study. SETTING the midwives had experience of working on delivery wards in maternity units with neonatal intensive care units (NICU) in Sweden. FINDINGS in the management of very preterm labour and birth, midwives agreed to initiate interventions concerning steroid prophylaxis at 23 gestational weeks (GW), caesarean section for preterm labour only at 25 GW, when to give information to the neonatologist before birth at 23 GW, and when to suggest transfer to NICU at 23 GW. Midwives at university hospitals were prone to start interventions at an earlier gestational age than the midwives at general hospitals. Midwives at university hospitals seemed to be more willing to disclose information to the parents. KEY CONCLUSIONS midwives with experience of handling very preterm births at 21-28 GW develop a positive attitude to interventions at an earlier gestational age as compared to midwives without such experience. IMPLICATIONS FOR PRACTICE based on these results we suggest more communication and transfer of information about the advances in perinatal care and exchange of knowledge between the staff at general and university hospitals. Establishment of platforms for inter-professional discussions about ethically difficult situations in perinatal care, might benefit the management of very preterm labour and birth.

58 Parental Education and Cognitive Profiles at 4 Years of Age in Healthy Very Preterm Children.

BACKGROUND: Improved survival rates for preterm and very low birthweight infants have increased attention towards their long-time neuro-developmental outcome, and particularly cognitive performances. To discriminate the effects of preterm birth from those of its neurological and sensorial consequences, we studied the cognitive function of a sample of healthy preterm children (no IVH stage 3–4; PLV; ROP grade 3–4) at pre-school age.METHODS: Thirty-five healthy preterm children (gestational age less than 33 weeks) were assessed at mean age of 4.4 years (SD 0.3) together with 50 controls born at term and matched for age and gender. Cases were selected from patients attending follow up at a large tertiary Pediatric Hospital. Griffiths scales were used to measure cognitive development. Multivariate regression analysis was adopted to simultaneously explore the effects of preterm birth and socio-demographic factors on cognitive score: parent age and education.RESULTS: Ninty-six % of global developmental Griffiths scores of both cases and controls were within 83–116, corresponding to the scale range of low to high average. However, global mean scores were lower for cases (97) than controls (103) and the difference was statistically significant (p<0.05). In particular, scores of preterm infants were significantly lower in four subscales: locomotor, hand and eye co-ordination, performance, practical reasoning. After adjusting for socio-demographic variables in multivariate analysis, the difference in global scores remained statistically significant (p<0.01). Maternal education was also significant predictor of cognitive development (p<0.05) with higher educational level corresponding to better children performances.CONCLUSIONS: These findings suggest that healthy preterm children at pre-school age, despite a global developmental score in the normal range, still show a lower developmental profile than their term peers, and maternal education also exerts a significant effect. Lower subscale scores point to specific areas of difficulty. These findings have implication for subsequent school performance and therapeutic interventions.