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Am J Perinatol 2021; 38(S 01): e193-e200
DOI: 10.1055/s-0040-1709128
Original Article

Ethical Cultures in Perinatal Care: Do They Exist? Correlation of Provider Attitudes with Periviability Practices at Six Centers

Christin Lawrence
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan
,
Naomi Laventhal
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan
,
Katie A. Fritz
2   Division of Neonatology, Tennessee Valley Neonatology, Huntsville, Alabama
,
Christine Carlos
3   Division of Neonatology, Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois
,
Mobolaji Famuyide
4   Division of Neonatology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
,
Tiffany Tonismae
5   Maternal, Fetal, & Neonatal Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
,
Drew Hayslett
6   Division of Pediatric Palliative Care, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
,
Tasha Coleman
4   Division of Neonatology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
,
Meenu Jain
7   Department of Internal Medicine, St Vincent Hospital, Indianapolis, Indiana
,
Brownsyne Tucker Edmonds
8   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Steven Leuthner
9   Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Bree Andrews
3   Division of Neonatology, Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois
,
Dalia M. Feltman 
10   Division of Neonatology, Department of Pediatrics, NorthShore Evanston Hospital, Evanston, Illinois
11   Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Illinois
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Funding Data management was possible through grant support for REDCap from NorthShore University HealthSystem.
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Abstract

Objective This study aimed to compare attitudes of providers regarding perinatal management and outcomes for periviable newborns of caregivers at centers with higher resuscitation (HR) and lower resuscitation (LR) rates in the delivery room.

Study Design All obstetric and neonatal clinical providers at six U.S. sites were invited to complete an anonymous online survey. Survey responses were compared with clinical data collected from a previous retrospective study comparing centers' rates of planned resuscitation. Responses were analyzed by multivariable logistic and linear regression to assess how HR versus LR center respondents differed in management preferences and outcome predictions.

Results Paradoxically, HR versus LR respondents, when adjusting for other variables, were less likely to respond that interventions such as antenatal steroids (odds ratio: 0.61, 95% confidence interval [CI]: 0.42–0.88, p < 0.009) and resuscitation (OR: 0.59, 95% CI: 0.44–0.78, p < 0.001) should be given at 22 weeks. HR versus LR respondents also reported lower likelihood of survival and acceptable quality of life (OR: 0.7, 95% CI: 0.53–0.93, p = 0.012) at 23 weeks.

Conclusion Despite higher rates of planned resuscitation at 22 and 23 weeks, steroid usage and survival rates did not differ between HR and LR sites. In this subsequent survey, respondents from HR centers had a less favorable outlook on interventions for these newborns than those at LR centers, suggesting that instead of driving practices, attitudes may be more closely associated with experiences of clinical outcomes.

Keywords

neonatology - decision-making - ethics - attitudes


Publikationsverlauf

Eingereicht: 11. November 2019

Angenommen: 25. Februar 2020

Artikel online veröffentlicht:
15. April 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 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
    CrossrefPubMedSuche in Google Scholar
  • 2 Patel RM, Rysavy MA, Bell EF, Tyson JE. Survival of infants born at periviable gestational ages. Clin Perinatol 2017; 44 (02) 287-303
    CrossrefPubMedSuche in Google Scholar
  • 3 Vohr BR, Wright LL, Dusick AM. et al; Neonatal Research Network. Center differences and outcomes of extremely low birth weight infants. Pediatrics 2004; 113 (04) 781-789
    CrossrefPubMedSuche in Google Scholar
  • 4 Bottoms SF, Paul RH, Mercer BM. et al. Obstetric determinants of neonatal survival: antenatal predictors of neonatal survival and morbidity in extremely low birth weight infants. Am J Obstet Gynecol 1999; 180 (3 Pt 1): 665-669
    CrossrefPubMedSuche in Google Scholar
  • 5 Janvier A, Barrington K, Deschênes M, Couture E, Nadeau S, Lantos J. Relationship between site of training and residents' attitudes about neonatal resuscitation. Arch Pediatr Adolesc Med 2008; 162 (06) 532-537
    CrossrefPubMedSuche in Google Scholar
  • 6 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
    CrossrefPubMedSuche in Google Scholar
  • 7 Feltman DM, Fritz KA, Datta A. et al. Antenatal periviability counseling and decision making: a retrospective examination by the investigating neonatal decisions for extremely early deliveries study group. Am J Perinatol 2019; 37 (02) 184-195
    PubMedSuche in Google Scholar
  • 8 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
    CrossrefPubMedSuche in Google Scholar
  • 9 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
    CrossrefPubMedSuche in Google Scholar
  • 10 Tyson JE, Parikh NA, Langer J, Green C, Higgins RD. ; National Institute of Child Health and Human Development Neonatal Research Network. Intensive care for extreme prematurity -- moving beyond gestational age. N Engl J Med 2008; 358 (16) 1672-1681
    CrossrefPubMedSuche in Google Scholar
  • 11 NICHD Neonatal Research Network (NRN). Extremely preterm birth outcome data. Eunice Kennedy Shriver National Institute of Child Health and Human Development. Accessed October 3, 2019 at: https://www.nichd.nih.gov/about/org/der/branches/ppb/programs/epbo
    PubMed
  • 12 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
    CrossrefPubMedSuche in Google Scholar
  • 13 Bottoms SF, Paul RH, Iams JD. et al; National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Obstetric determinants of neonatal survival: influence of willingness to perform cesarean delivery on survival of extremely low-birth-weight infants. Am J Obstet Gynecol 1997; 176 (05) 960-966
    CrossrefPubMedSuche in Google Scholar
  • 14 Edmonds BT, McKenzie F, Hendrix KS, Perkins SM, Zimet GD. The influence of resuscitation preferences on obstetrical management of periviable deliveries. J Perinatol 2015; 35 (03) 161-166
    CrossrefPubMedSuche in Google Scholar
  • 15 Guinsburg R, Branco de Almeida MF, Dos Santos Rodrigues Sadeck L. et al; Brazilian Network on Neonatal Research. Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists. J Perinatol 2012; 32 (12) 913-919
    CrossrefPubMedSuche in Google Scholar
  • 16 Ramsay SM, Santella RM. The definition of life: a survey of obstetricians and neonatologists in New York City hospitals regarding extremely premature births. Matern Child Health J 2011; 15 (04) 446-452
    CrossrefPubMedSuche in Google Scholar
  • 17 Arzuaga BH, Cummings CL. Practices and education surrounding anticipated periviable deliveries among neonatal-perinatal medicine and maternal-fetal medicine fellowship programs. J Perinatol 2016; 36 (09) 699-703
    CrossrefPubMedSuche in Google Scholar
  • 18 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
    CrossrefPubMedSuche in Google Scholar
  • 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
    CrossrefPubMedSuche in Google Scholar
  • 20 Shepardson LB, Gordon HS, Ibrahim SA, Harper DL, Rosenthal GE. Racial variation in the use of do-not-resuscitate orders. J Gen Intern Med 1999; 14 (01) 15-20
    CrossrefPubMedSuche in Google Scholar
  • 21 Donohue PK, Boss RD, Aucott SW, Keene EA, Teague P. The impact of neonatologists' religiosity and spirituality on health care delivery for high-risk neonates. J Palliat Med 2010; 13 (10) 1219-1224
    CrossrefPubMedSuche in Google Scholar
  • 22 Arzuaga B, Adam H, Ahmad M, Padela A. Attitudes towards the resuscitation of periviable infants: a national survey of American Muslim physicians. Acta Paediatr (Oslo, Norway: 1992) 2016; 105 (03) 260-267
    CrossrefPubMedSuche in Google Scholar
  • 23 Catlin EA, Cadge W, Ecklund EH, Gage EA, Zollfrank AA. The spiritual and religious identities, beliefs, and practices of academic pediatricians in the United States. Acad Med 2008; 83 (12) 1146-1152
    CrossrefPubMedSuche in Google Scholar
  • 24 Famuyide M, Compretta C, Ellis M. Neonatal nurse practitioner ethics knowledge and attitudes. Nurs Ethics 2019; 26 (7-8): 2247-2258
    CrossrefPubMedSuche in Google Scholar