144 An Alternative Approach to Developing Guidelines for the Management of Infants Born at the Threshold of Viability
Bibliographic record
Abstract
Guidelines for resuscitation of infants at the threshold of viability (ToV) based on gestational age (GA) are criticized for ‘gestational ageism’ and become outdated. If probability of survival and neurodevelopmental outcomes were considered instead of GA, bias could be minimized. The study objective is to identify the probability of survival and severe neurodevelopmental impairment (sNDI) at which perinatal health care providers (pHCPs) would or would not provide or recommend resuscitation for infants at the ToV. A Delphi process consisting of five rounds was implemented to seek consensus (>80% agreement) amongst pHCPs in BC. The first-round consisted of 2 Neonatology and 2 Maternal-Fetal-Medicine (MFM) Focus Groups. Rounds 2–4 involved surveys of pHCPs, building upon results of previous rounds. For round 5, draft ToV statements were developed and agreement sought. Focus Groups (20 participants) agreed: (1) guidelines are useful; (2) sNDI is important in decision-making. There were 403 survey responses in Rounds 2–5. The final survey had 148 responses (45% paediatricians, 24% obstetricians, 18% (all) neonatologists, 13% (most) MFM). Consensus was reached for the following statements: 1. If expected chance of survival < 5%, resuscitation should not be offered (93% Agree). 2. If expected chance of survival < 10%, resuscitation should not be recommended (87% Agree). 3. If expected chance of survival without sNDI > 10% but < 70%, well-informed, capable parent(s) should decide about resuscitation (87% Agree). 4. If expected chance of survival without sNDI > 70% but < 90%, resuscitation is recommended (81% Agree). 5. If expected chance of survival without sNDI > 90%, the baby should be resuscitated, even against parental wishes (84% Agree). Objective ToV guidelines based on pHCP’s consensus can be developed. The above five statements form the basis for revised BC ToV management guidelines, which can be rapidly updated with local outcome data.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.055 | 0.116 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.003 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.004 | 0.007 |
| Scholarly communication | 0.011 | 0.007 |
| Open science | 0.005 | 0.008 |
| Research integrity | 0.011 | 0.008 |
| Insufficient payload (model declined to judge) | 0.028 | 0.006 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".