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

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

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)184-195
Number of pages12
JournalAmerican Journal of Perinatology
Volume37
Issue number2
DOIs
StatePublished - Jan 1 2020
Externally publishedYes

Keywords

  • decision making
  • neonatology
  • race

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

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    Feltman, D. M., Fritz, K. A., Datta, A., Carlos, C., Hayslett, D., Tonismae, T., Lawrence, C., Batton, E., Coleman, T., Jain, M., Andrews, B., Famuyide, M., Tucker Edmonds, B., Laventhal, N., & Leuthner, S. (2020). Antenatal Periviability Counseling and Decision Making: A Retrospective Examination by the Investigating Neonatal Decisions for Extremely Early Deliveries Study Group. American Journal of Perinatology, 37(2), 184-195. https://doi.org/10.1055/s-0039-1694792