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

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.

• Authors: 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
• Journal: American journal of perinatology (Am J Perinatol) Vol. 37 Issue 2 Pg. 184-195 (01 2020) ISSN: 1098-8785 [Electronic] United States
• PMID: 31437859 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Topics

• Birth Weight
• Counseling
• Decision Making
• Female
• Fetal Viability
• Humans
• Infant, Extremely Premature
• Infant, Newborn
• Mothers
• Neonatology
• Patient Care Team
• Pregnancy
• Premature Birth
• Prenatal Care
• Racial Groups
• Resuscitation Orders
• Retrospective Studies