Counseling Pregnant Women Who May Deliver Extremely Premature Infants: Medical Care Guidelines, Family Choices, and Neonatal Outcomes

Kaempf, Joseph W.; Tomlinson, Mark; Campbell, Betty; Ferguson, Linda A.; Stewart, Valerie T.

doi:10.1542/peds.2008-2215

Cited by 108 publications

(80 citation statements)

References 26 publications

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“…70 Such guidance can be effectively used to counsel parents and to improve communication and consistency between service providers. 71 A general approach to communication is suggested in the latest edition of the American Academy of Pediatrics/ American Heart Association Textbook of Neonatal Resuscitation:…”

Section: Developing and Improving Communication Skillsmentioning

confidence: 99%

Antenatal Counseling Regarding Resuscitation and Intensive Care Before 25 Weeks of Gestation

Cummings¹,

Watterberg²,

Eichenwald³

et al. 2015

Pediatrics

236

133

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The anticipated birth of an extremely low gestational age (<25 weeks) infant presents many difficult questions, and variations in practice continue to exist. Decisions regarding care of periviable infants should ideally be well informed, ethically sound, consistent within medical teams, and consonant with the parents’ wishes. Each health care institution should consider having policies and procedures for antenatal counseling in these situations. Family counseling may be aided by the use of visual materials, which should take into consideration the intellectual, cultural, and other characteristics of the family members. Although general recommendations can guide practice, each situation is unique; thus, decision-making should be individualized. In most cases, the approach should be shared decision-making with the family, guided by considering both the likelihood of death or morbidity and the parents’ desires for their unborn child. If a decision is made not to resuscitate, providing comfort care, encouraging family bonding, and palliative care support are appropriate.

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Section: Developing and Improving Communication Skillsmentioning

confidence: 99%

Antenatal Counseling Regarding Resuscitation and Intensive Care Before 25 Weeks of Gestation

Cummings¹,

Watterberg²,

Eichenwald³

et al. 2015

Pediatrics

236

133

View full text Add to dashboard Cite

show abstract

“…We assumed that infants born at $25 weeks' GA were likely to receive aggressive obstetric and neonatal care, whereas infants born before 25 weeks might have had less aggressive care before and after birth. 14 …”

mentioning

confidence: 99%

Individual and Center-Level Factors Affecting Mortality Among Extremely Low Birth Weight Infants

Alleman

Bell

et al. 2013

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Significant variation in the mortality of preterm infants has been observed among NICUs. Factors explaining this variation have been difficult to identify.WHAT THIS STUDY ADDS: Sizable center differences in mortality exist, even among similarly sized NICUs in academic centers. Patient characteristics and center treatment rates explain some of the center effect, especially for the youngest infants, but a significant portion of these differences remains unexplained. abstract OBJECTIVE: To examine factors affecting center differences in mortality for extremely low birth weight (ELBW) infants. METHODS:We analyzed data for 5418 ELBW infants born at 16 Neonatal Research Network centers during [2006][2007][2008][2009]. The primary outcomes of early mortality (#12 hours after birth) and in-hospital mortality were assessed by using multilevel hierarchical models. Models were developed to investigate associations of center rates of selected interventions with mortality while adjusting for patient-level risk factors. These analyses were performed for all gestational ages (GAs) and separately for GAs ,25 weeks and $25 weeks. RESULTS:Early and in-hospital mortality rates among centers were 5% to 36% and 11% to 53% for all GAs, 13% to 73% and 28% to 90% for GAs ,25 weeks, and 1% to 11% and 7% to 26% for GAs $25 weeks, respectively. Center intervention rates significantly predicted both early and in-hospital mortality for infants ,25 weeks. For infants $25 weeks, intervention rates did not predict mortality. The variance in mortality among centers was significant for all GAs and outcomes. Center use of interventions and patient risk factors explained some but not all of the center variation in mortality rates. CONCLUSIONS:Center intervention rates explain a portion of the center variation in mortality, especially for infants born at ,25 weeks' GA. This finding suggests that deaths may be prevented by standardizing care for very early GA infants. However, differences in patient characteristics and center intervention rates do not account for all of the observed variability in mortality; and for infants with GA $25 weeks these differences account for only a small part of the variation in mortality. Pediatrics 2013;132:e175-e184 Mr Alleman participated in the conception and design of the study including the analysis plan and in the interpretation of the data and wrote the first and subsequent drafts of the manuscript and helped to revise it critically for important intellectual content; Dr Bell conceived and helped to design the study including the analysis plan, participated in the interpretation of the data, and revised the manuscript critically for important intellectual content; Dr Li helped to design the analysis plan and was responsible for the data management and analysis, performed the analysis with guidance from Mr Alleman and Dr Bell and with advice from Drs Das and Wallace, and helped to revise the manuscript critically for important intellectual content; Both patient factors (eg, gestatio...

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“…Counselling was shown to increase the woman's understanding of the information concerning her preterm infant (Kaempf et al, 2009). Midwives, in the study by Garel et al, (2004) felt that parents were not adequately informed and were not always listened to.…”

Section: Discussion Of the Findingsmentioning

confidence: 92%

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

et al. 2012

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Counseling Pregnant Women Who May Deliver Extremely Premature Infants: Medical Care Guidelines, Family Choices, and Neonatal Outcomes

Cited by 108 publications

References 26 publications

Antenatal Counseling Regarding Resuscitation and Intensive Care Before 25 Weeks of Gestation

Antenatal Counseling Regarding Resuscitation and Intensive Care Before 25 Weeks of Gestation

Individual and Center-Level Factors Affecting Mortality Among Extremely Low Birth Weight Infants

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

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