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Am J Perinatol 2021; 38(S 01): e193-e200
DOI: 10.1055/s-0040-1709128
Original Article

Ethical Cultures in Perinatal Care: Do They Exist? Correlation of Provider Attitudes with Periviability Practices at Six Centers

Christin Lawrence
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan
,
Naomi Laventhal
1   Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan C.S. Mott Children's Hospital, Ann Arbor, Michigan
,
Katie A. Fritz
2   Division of Neonatology, Tennessee Valley Neonatology, Huntsville, Alabama
,
Christine Carlos
3   Division of Neonatology, Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois
,
Mobolaji Famuyide
4   Division of Neonatology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
,
Tiffany Tonismae
5   Maternal, Fetal, & Neonatal Institute, Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
,
Drew Hayslett
6   Division of Pediatric Palliative Care, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
,
Tasha Coleman
4   Division of Neonatology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
,
Meenu Jain
7   Department of Internal Medicine, St Vincent Hospital, Indianapolis, Indiana
,
Brownsyne Tucker Edmonds
8   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
,
Steven Leuthner
9   Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
,
Bree Andrews
3   Division of Neonatology, Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, Illinois
,
Dalia M. Feltman 
10   Division of Neonatology, Department of Pediatrics, NorthShore Evanston Hospital, Evanston, Illinois
11   Department of Pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Illinois
› Author Affiliations Funding Data management was possible through grant support for REDCap from NorthShore University HealthSystem.
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Abstract

Objective This study aimed to compare attitudes of providers regarding perinatal management and outcomes for periviable newborns of caregivers at centers with higher resuscitation (HR) and lower resuscitation (LR) rates in the delivery room.

Study Design All obstetric and neonatal clinical providers at six U.S. sites were invited to complete an anonymous online survey. Survey responses were compared with clinical data collected from a previous retrospective study comparing centers' rates of planned resuscitation. Responses were analyzed by multivariable logistic and linear regression to assess how HR versus LR center respondents differed in management preferences and outcome predictions.

Results Paradoxically, HR versus LR respondents, when adjusting for other variables, were less likely to respond that interventions such as antenatal steroids (odds ratio: 0.61, 95% confidence interval [CI]: 0.42–0.88, p < 0.009) and resuscitation (OR: 0.59, 95% CI: 0.44–0.78, p < 0.001) should be given at 22 weeks. HR versus LR respondents also reported lower likelihood of survival and acceptable quality of life (OR: 0.7, 95% CI: 0.53–0.93, p = 0.012) at 23 weeks.

Conclusion Despite higher rates of planned resuscitation at 22 and 23 weeks, steroid usage and survival rates did not differ between HR and LR sites. In this subsequent survey, respondents from HR centers had a less favorable outlook on interventions for these newborns than those at LR centers, suggesting that instead of driving practices, attitudes may be more closely associated with experiences of clinical outcomes.

Keywords

neonatology - decision-making - ethics - attitudes


Publication History

Received: 11 November 2019

Accepted: 25 February 2020

Article published online:
15 April 2020

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