Delivery room decision-making at the threshold of viability

Peerzada, Jehanna; Richardson, Douglas K.; Burns, Jeffrey P.

doi:10.1016/j.jpeds.2004.06.018

Cited by 102 publications

(70 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…[8][9][10][11][12][13][14][15][16][17][18] Estimated gestational age has served as the basis for estimating these risks for parents because of its strong association with outcome. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] However, there are limitations of using estimated gestational age alone for antenatal counseling purposes. One limitation is that the length of gestation is rarely certain to the precise day, except when conception occurred via in vitro fertilization.…”

Section: Factors To Consider When Counseling Parentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…5 Uncertainty exists, however, for infants between these 2 extremes, when it is unclear whether resuscitation is in the infant's best interest. 5 For these infants, selective resuscitation on the basis of parental preference is often considered to be an appropriate option, and general guidelines for decision-making are commonly based onestimatedgestationalage. [1][2][3][4][5] TheNuffield Council on Bioethics suggests that infants born from 22 0 ⁄ 7 through 23 6 ⁄ 7 weeks' gestation should be considered candidates for selective resuscitation.…”

Section: Introductionmentioning

confidence: 99%

“…5 For these infants, selective resuscitation on the basis of parental preference is often considered to be an appropriate option, and general guidelines for decision-making are commonly based onestimatedgestationalage. [1][2][3][4][5] TheNuffield Council on Bioethics suggests that infants born from 22 0 ⁄ 7 through 23 6 ⁄ 7 weeks' gestation should be considered candidates for selective resuscitation. 4 They also state that from 24 0 ⁄ 7 through 24 6 ⁄ 7 weeks' gestation, the "normal practice should be that a baby will be offered full invasive intensive care and support from birth and admitted to a neonatal intensive care unit unless the parents and the clinicians are agreed that in light of the baby's condition it is not in his or her best interests to start intensive care."…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Antenatal Counseling Regarding Resuscitation at an Extremely Low Gestational Age

Batton¹,

Newborn²

2009

Pediatrics

182

120

View full text Add to dashboard Cite

The anticipated delivery of an extremely low gestational age infant raises difficult questions for all involved, including whether to initiate resuscitation after delivery. Each institution caring for women at risk of delivering extremely preterm infants should provide comprehensive and consistent guidelines for antenatal counseling. Parents should be provided the most accurate prognosis possible on the basis of all the factors known to affect outcome for a particular case. Although it is not feasible to have specific criteria for when the initiation of resuscitation should or should not be offered, the following general guidelines are suggested. If the physicians involved believe there is no chance for survival, resuscitation is not indicated and should not be initiated. When a good outcome is considered very unlikely, the parents should be given the choice of whether resuscitation should be initiated, and clinicians should respect their preference. Finally, if a good outcome is considered reasonably likely, clinicians should initiate resuscitation and, together with the parents, continually reevaluate whether intensive care should be continued. Whenever resuscitation is considered an option, a qualified individual, preferably a neonatologist, should be involved and should be present in the delivery room to manage this complex situation. Comfort care should be provided for all infants for whom resuscitation is not initiated or is not successful.

show abstract

Section: Factors To Consider When Counseling Parentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Antenatal Counseling Regarding Resuscitation at an Extremely Low Gestational Age

Batton¹,

Newborn²

2009

Pediatrics

182

120

View full text Add to dashboard Cite

show abstract

“…However, at the soft edges of viability, where futility remains debatable even within the medical profession, 60 matters become far more problematic. First, nowhere in the House report does the Majority acknowledge without qualification that discretion to decide the fate of imperiled newborns invests in parents, in consultation with physicians; indeed, one of the bill's stated purposes was "to repudiate the flawed notion that a child's entitlement to the protections of the law is dependent on whether that child's mother or others want him or her."…”

Section: Statutory Construction Legislative Intent and The Courtsmentioning

confidence: 99%

Baby Doe Redux? The Department of Health and Human Services and the Born-Alive Infants Protection Act of 2002: A Cautionary Note on Normative Neonatal Practice

Sayeed

2005

Pediatrics

View full text Add to dashboard Cite

ABSTRACT. The Born-Alive Infants Protection Act (BAIPA), passed by Congress in 2002, has attracted little publicity. Its purposes were, in part, "to repudiate the flawed notion that a child's entitlement to the protections of the law is dependent on whether that child's mother or others want him or her." Understood as antiabortion rhetoric, the bill raised little concern among physicians at the time of legislative hearings and passed in both Houses by overwhelming majorities, hardly suggesting contentious legislation. After its signing into law, the Neonatal Resuscitation Program (NRP) Steering Committee issued an opinion stating that " [BAIPA] should not in any way affect the approach that physicians currently follow with respect to the extremely premature infant." This interpretation of the law, however, may have been short sighted.In April 2005, the US Department of Health and Human Services (DHHS) brought life to the BAIPA, announcing: "As a matter of law and policy, [DHHS] will investigate all circumstances where individuals and entities are reported to be withholding medical care from an infant born alive in potential violation of federal statutes." The agency issued instructions to state officials on how the definitional provision within the BAIPA interacts with the Emergency Medical Treatment and Labor Act (EMTALA) and the Child Abuse Prevention and Treatment Act (CAPTA). These interagency memoranda potentially resurrect dormant governmental oversight of newborn-treatment decisions and thus may have influence over normative neonatal practice.Under the BAIPA, the DHHS interprets EMTALA to protect all "born-alive" infants; hospitals and physicians violating regulatory requirements face agency-sanctioned monetary penalties or a "private right of action by any individual harmed as a direct result." According to its memorandum, the DHHS will investigate allegations of EMTALA violations whenever it finds evidence that a newborn was not provided with at least a medical screening examination under circumstances in which a "prudent layperson observer" could conclude from the infant's "appearance or behavior" that it was "suffering from an emergency medical condition." The memorandum fails to clarify which observers qualify as prudent, what infant appearance or behavior is relevant, or what defines an emergency medical condition. Because these evaluative criteria are not constrained by reference to relevant standards of medical care, the agency arguably substitutes a nonprofessional's presumed sagacious assessment of survivability for reasonable medical judgment.Indeed, under a straightforward reading of the instruction, a family member could conceivably trigger an investigation after observing a relative deliver a 20-week fetus who maintains a heartbeat for an hour before its death. Most physicians would not consider this an emergency medical condition and, rather than perform a screening examination, would provide comfort for the newborn and support for the family. The guideline, however, does not state that pr...

show abstract

Physician and Parental Decision Making in Newborn Resuscitation

Eichenwald

Chervenak²,

McCullough³

2008

AMA Journal of Ethics

View full text Add to dashboard Cite

An ultrasound performed on a woman who was 23-weeks pregnant revealed multiple findings suspicious for trisomy 21 syndrome, (Down syndrome). The woman and her husband were devastated, saying they could not possibly raise a child with mental retardation and physical anomalies, and they requested a termination. The obstetrician recommended amniocentesis for chromosomal analysis that would give definitive diagnosis of trisomy 21, and the test was performed. The parents said they planned to terminate the pregnancy if the results of the chromosome analysis confirmed Down syndrome.Before the results were returned, the woman arrived at the labor and delivery unit with a tender abdomen, purulent discharge from the cervix, and high fever. She appeared to have an acute intrauterine infection from the amniocentesis procedure. Antibiotics were started, but it soon became clear that the woman was becoming septic; the obstetrician on call recommended rapid delivery of the fetus. The woman and her husband again clearly stated that they wanted no resuscitation performed on the infant after delivery. The couple and the physicians agreed that, given the probability of a severely anomalous infant, the plan would be to provide only comfort care measures.

show abstract

Delivery room decision-making at the threshold of viability

Cited by 102 publications

References 43 publications

Antenatal Counseling Regarding Resuscitation at an Extremely Low Gestational Age

Antenatal Counseling Regarding Resuscitation at an Extremely Low Gestational Age

Baby Doe Redux? The Department of Health and Human Services and the Born-Alive Infants Protection Act of 2002: A Cautionary Note on Normative Neonatal Practice

Physician and Parental Decision Making in Newborn Resuscitation

Contact Info

Product

Resources

About