Perinatal Counseling at the Margin of Gestational Viability: Where We’ve Been, Where We’re Going, and How to Navigate a Path Forward

Arnolds, Marin; Laventhal, Naomi

doi:10.1016/j.jpeds.2021.02.006

Cited by 11 publications

(16 citation statements)

References 73 publications

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“…To better support parents through the perinatal period, physicians must develop the skills to guide parents in articulating their values, including those of religion and spirituality, and then help to connect the medical information to what is most important to their family. 32–35 Exploration and support of parental spirituality by social work, palliative care, and chaplaincy are necessary and important, yet may leave neonatologists unaware of the values that influence decision making.…”

Section: Discussionmentioning

confidence: 99%

Neonatologists' Perspectives on Exploring Parental Spirituality in Prenatal Consultations

Peralta

Moore

Bierer

2023

Palliative Medicine Reports

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Section: Discussionmentioning

confidence: 99%

Neonatologists' Perspectives on Exploring Parental Spirituality in Prenatal Consultations

Peralta

Moore

Bierer

2023

Palliative Medicine Reports

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“…The narrow guidelines for resuscitation at the margin of viability guidelines used in HICs were designed for clinical settings with reliable access to medical technology and supplies, and may not be feasible or appropriate in resource-constrained settings. Likewise, the ethical framework guiding periviable resuscitation decisions in the US and Europe developed in parallel to the advancing lifesaving technology, and were influenced by iterative evaluation of cultural and societal values about preserving life, avoiding harm, and allowing parental authority [ 21 ]. It is inappropriate to assume that healthcare professionals and parents in LMICs should adhere to ethical constructs developed within a culture distinct from their own.…”

Section: Discussionmentioning

confidence: 99%

“…For these patients, resuscitation is offered but not obligatory, and parental authority guides the decision whether to pursue intensive therapies. Due to the high degree of prognostic uncertainty for individual infants delivered at extremely preterm gestations, there remains continued debate regarding what the thresholds should be for offering and obligating resuscitation, and how these thresholds should be determined [ 20 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

Perspectives on Resuscitation Decisions at the Margin of Viability among Specialist Newborn Care Providers in Ghana and Ethiopia: A Qualitative Analysis

et al. 2022

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Background In high income countries, guidelines exist recommending gestational age thresholds for offering and obligating neonatal resuscitation for extremely preterm infants. In low- and middle- income countries, this approach may be impractical due to limited/inconsistent resource availability and challenges in gestational dating. Scant literature exists on how clinicians in these settings conceptualize viability or make resuscitation decisions for premature infants. Methods Qualitative interviews of interprofessional neonatal clinicians were conducted in Kumasi, Ghana, at Komfo Anokye Teaching Hospital and Suntreso Government Hospital, and in Addis Ababa, Ethiopia, at St. Paul’s Hospital Millennium Medical College. Transcribed interviews were coded through the constant comparative method. Results Three discrete major themes were identified. The principal theme was a respect for all life, regardless of the likelihood for survival. This sense of duty arose from a duty to God, a duty to the patient, and a duty intrinsic to one’s role as a medical provider. The duty to resuscitate was balanced by the second major theme, an acceptance of futility for many premature infants. Lack of resources, inappropriate staffing, and historically high local neonatal mortality rates were often described. The third theme was a desire to meet global standards of newborn care, including having resources to adopt the 22–25-week thresholds used in high income countries and being able to consistently provide life-saving measures to premature infants. Conclusions Neonatal clinicians in Ghana and Ethiopia described respect for all life and desire to meet global standards of newborn care, balanced with an awareness of futility based on local resource limitations. In both countries, clinicians highlighted how wide variations in regional survival outcomes limited their ability to rely on structured resuscitation guidelines based on gestational age and/or birthweight.

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“…A so-called "gray zone of parental discretion" exists, in which parents and physicians make treatment decisions together [1][2][3][4][5]. The exact definition of this zone, in terms of i.e.…”

Section: Introductionmentioning

confidence: 99%

“…gestational age, changed over time. Furthermore, this gray zone can differ across countries, health systems and cultures [4,[6][7][8]. Despite different definitions of this gray zone of parental discretion, parental counseling is needed to agree on the preferred treatment option, ideally based on shared decision making between the pregnant woman, her partner (further referred to as parents), van obstetrician and neonatologist [9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Digital decision aid for prenatal counseling in imminent extreme premature labor: development and pilot testing

Heuvel

Hogeveen

Holzik

et al. 2022

BMC Med Inform Decis Mak

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Background In case of extreme premature delivery at 24 weeks of gestation, both early intensive care and palliative comfort care for the neonate are considered treatment options. Prenatal counseling, preferably using shared decision making, is needed to agree on the treatment option in case labor progresses. This article described the development of a digital decision aid (DA) to support pregnant women, partners and clinicians in prenatal counseling for imminent extreme premature labor. Methods This DA is developed following the International Patient Decision Aid Standards. The Dutch treatment guideline and the Dutch recommendations for prenatal counseling in extreme prematurity were used as basis. Development of the first prototype was done by expert clinicians and patients, further improvements were done after alpha testing with involved clinicians, patients and other experts (n = 12), and beta testing with non-involved clinicians and patients (n = 15). Results The final version includes information, probabilities and figures depending on users’ preferences. Furthermore, it elicits patient values and provides guidance to aid parents and professionals in making a decision for either early intensive care or palliative comfort care in threatening extreme premature delivery. Conclusion A decision aid was developed to support prenatal counseling regarding the decision on early intensive care versus palliative comfort care in case of extreme premature delivery at 24 weeks gestation. It was well accepted by parents and healthcare professionals. Our multimedia, digital DA is openly available online to support prenatal counseling and personalized, shared decision-making in imminent extreme premature labor.

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Perinatal Counseling at the Margin of Gestational Viability: Where We’ve Been, Where We’re Going, and How to Navigate a Path Forward

Cited by 11 publications

References 73 publications

Neonatologists' Perspectives on Exploring Parental Spirituality in Prenatal Consultations

Neonatologists' Perspectives on Exploring Parental Spirituality in Prenatal Consultations

Perspectives on Resuscitation Decisions at the Margin of Viability among Specialist Newborn Care Providers in Ghana and Ethiopia: A Qualitative Analysis

Digital decision aid for prenatal counseling in imminent extreme premature labor: development and pilot testing

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