Antenatal Periviability Counseling and Decision Making: A Retrospective Examination by the Investigating Neonatal Decisions for Extremely Early Deliveries Study Group

Dalia M. Feltman; Katie A. Fritz; Avisek Datta; Christine Carlos; Drew Hayslett; Tiffany Tonismae; Christin Lawrence; Emily Batton; Tasha Coleman; Meenu Jain; Bree Andrews; Mobolaji Famuyide; Brownsyne Tucker Edmonds; Naomi Laventhal; Steven Leuthner

doi:10.1055/s-0039-1694792

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2020; 37(02): 184-195
DOI: 10.1055/s-0039-1694792

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Antenatal Periviability Counseling and Decision Making: A Retrospective Examination by the Investigating Neonatal Decisions for Extremely Early Deliveries Study Group

Dalia M. Feltman

¹Division of Neonatology, Department of Pediatrics, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois

²Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Illinois

,

Katie A. Fritz

³Tennessee Valley Neonatology, Huntsville, Alabama

,

Avisek Datta

⁴Department of Research, NorthShore University HealthSystem Research Institute, Evanston, Illinois

,

Christine Carlos

⁵Division of Neonatology, Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois

,

Drew Hayslett

⁶Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi

,

Tiffany Tonismae

⁷Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana

,

Christin Lawrence

⁸Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan

,

Emily Batton

⁹Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois

,

Tasha Coleman

¹⁰Division of Neonatology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi

,

Meenu Jain

¹¹Department of Internal Medicine, St Vincent Hospital, Indianapolis, Indiana

,

Bree Andrews

⁵Division of Neonatology, Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois

,

Mobolaji Famuyide

¹⁰Division of Neonatology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi

,

Brownsyne Tucker Edmonds

⁷Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana

,

Naomi Laventhal

⁸Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan

,

Steven Leuthner

¹²Department of Pediatrics, Division of Neonatology, Medical College of Wisconsin, Milwaukee, Wisconsin

› Institutsangaben

Abstract

Objective To describe periviability counseling practices and decision making.

Study Design This is a retrospective review of mothers and newborns delivering between 22 and 24 completed weeks from 2011 to 2015 at six U.S. centers. Maternal and fetal/neonatal clinical and maternal sociodemographic data from medical records and geocoded sociodemographic information were collected. Separate analyses examined characteristics surrounding receiving neonatology consultation; planning neonatal resuscitation; and centers' planned resuscitation rates.

Results Neonatology consultations were documented for 40, 63, and 72% of 498 mothers delivering at 22, 23, and 24 weeks, respectively. Consult versus no-consult mothers had longer median admission-to-delivery intervals (58.7 vs. 8.7 h, p < 0.001). Consultations were seen more frequently when parental decision making was evident. In total, 76% of mothers had neonatal resuscitation planned. Resuscitation versus no-resuscitation newborns had higher mean gestational ages (24.0 vs. 22.9 weeks, p < 0.001) and birthweights (618 vs. 469 g, p < 0.001). Planned resuscitation rates differed at higher (HR) versus lower (LR) rate centers at 22 (43 vs. 7%, p < 0.001) and 23 (85 vs. 58%, p < 0.001) weeks. HR versus LR centers' populations had more socioeconomic hardship markers but fewer social work consultations (odds ratio: 0.31; confidence interval: 0.15–0.59, p < 0.001).

Conclusion Areas requiring improvement included delivery/content of neonatology consultations, social work support, consideration of centers' patient populations, and opportunities for shared decisions.

Keywords

neonatology - race - decision making

Volltext

Referenzen

References
1 Cummings J. ; Committee on Fetus and Newborn. Antenatal counseling regarding resuscitation and intensive care before 25 weeks of gestation. Pediatrics 2015; 136 (03) 588-595
2 Batton DG. ; Committee on Fetus and Newborn. Clinical report--antenatal counseling regarding resuscitation at an extremely low gestational age. Pediatrics 2009; 124 (01) 422-427
3 Raju TN, Mercer BM, Burchfield DJ, Joseph GF. Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. J Perinatol 2014; 34 (05) 333-342
4 Krick JA, Feltman DM. Neonatologists' preferences regarding guidelines for periviable deliveries: do we really know what we want?. J Perinatol 2019; 39 (03) 445-452
5 Rysavy MA, Li L, Bell EF. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med 2015; 372 (19) 1801-1811
6 Duffy D, Reynolds P. Babies born at the threshold of viability: attitudes of paediatric consultants and trainees in South East England. Acta Paediatr 2011; 100 (01) 42-46
7 Feltman DM, Williams DD, Carter BS. How are neonatology fellows trained for antenatal periviability counseling?. Am J Perinatol 2017; 34 (13) 1279-1285
8 Hileli I, Weyl Ben Arush M, Hakim F, Postovsky S. Association between religious and socio-economic background of parents of children with solid tumors and DNR orders. Pediatr Blood Cancer 2014; 61 (02) 265-268
9 Roy R, Aladangady N, Costeloe K, Larcher V. Decision making and modes of death in a tertiary neonatal unit. Arch Dis Child Fetal Neonatal Ed 2004; 89 (06) F527-F530
10 Eventov-Friedman S, Kanevsky H, Bar-Oz B. Neonatal end-of-life care: a single-center NICU experience in Israel over a decade. Pediatrics 2013; 131 (06) e1889-e1896
11 U.S. Census Bureau. (2015). Selected data, 2011–2015 American Community Survey 5-year estimates. Available at: https://factfinder.census.gov/faces/nav/jsf/pages/programs.xhtml?program=acs . Accessed August 1, 2018
12 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
13 Haward MF, Gaucher N, Payot A, Robson K, Janvier A. Personalized decision making: practical recommendations for antenatal counseling for fragile neonates. Clin Perinatol 2017; 44 (02) 429-445
14 Lantos JD. Ethical problems in decision making in the neonatal ICU. N Engl J Med 2018; 379 (19) 1851-1860
15 Atwell K, Callander E, Lindsay D, Marshall PB, Morris SA. Selection bias and outcomes for preterm neonates. Pediatrics 2018; 142 (01) e20180470
16 Leuthner SR. Borderline viability: controversies in caring for the extremely premature infant. Clin Perinatol 2014; 41 (04) 799-814
17 Anderson JG, Baer RJ, Partridge JC. , et al. Survival and major morbidity of extremely preterm infants: a population-based study. Pediatrics 2016; 138 (01) 1-13
18 Meadow W, Lagatta J, Andrews B, Lantos J. The mathematics of morality for neonatal resuscitation. Clin Perinatol 2012; 39 (04) 941-956
19 Tucker Edmonds B, Fager C, Srinivas S, Lorch S. Racial and ethnic differences in use of intubation for periviable neonates. Pediatrics 2011; 127 (05) e1120-e1127
20 Winker MA. Race and ethnicity in medical research: requirements meet reality. J Law Med Ethics 2006; 34 (03) 520-525
21 Hellmann J, Knighton R, Lee SK, Shah PS. ; Canadian Neonatal Network End of Life Study Group. Neonatal deaths: prospective exploration of the causes and process of end-of-life decisions. Arch Dis Child Fetal Neonatal Ed 2016; 101 (02) F102-F107
22 Phibbs CS, Baker LC, Caughey AB, Danielsen B, Schmitt SK, Phibbs RH. Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. N Engl J Med 2007; 356 (21) 2165-2175