Am J Perinatol 2020; 37(02): 184-195
DOI: 10.1055/s-0039-1694792
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

Dalia M. Feltman
1   Division of Neonatology, Department of Pediatrics, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois
2   Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Illinois
,
Katie A. Fritz
3   Tennessee Valley Neonatology, Huntsville, Alabama
,
Avisek Datta
4   Department of Research, NorthShore University HealthSystem Research Institute, Evanston, Illinois
,
Christine Carlos
5   Division of Neonatology, Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois
,
Drew Hayslett
6   Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
,
Tiffany Tonismae
7   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Christin Lawrence
8   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan
,
Emily Batton
9   Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois
,
Tasha Coleman
10   Division of Neonatology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
,
Meenu Jain
11   Department of Internal Medicine, St Vincent Hospital, Indianapolis, Indiana
,
Bree Andrews
5   Division of Neonatology, Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois
,
Mobolaji Famuyide
10   Division of Neonatology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
,
Brownsyne Tucker Edmonds
7   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Naomi Laventhal
8   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan
,
Steven Leuthner
12   Department of Pediatrics, Division of Neonatology, Medical College of Wisconsin, Milwaukee, Wisconsin
› Author Affiliations
Further Information

Publication History

22 May 2019

09 July 2019

Publication Date:
22 August 2019 (online)

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.

 
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