Medical Staff Guidelines for Periviability Pregnancy Counseling and Medical Treatment of Extremely Premature Infants

  title={Medical Staff Guidelines for Periviability Pregnancy Counseling and Medical Treatment of Extremely Premature Infants},
  author={Joseph W. Kaempf and Mark W. Tomlinson and Cindy Arduza and Shelly Anderson and Betty Campbell and Linda Ferguson and Mara Zabari and Valerie T Stewart},
  pages={22 - 29}
OBJECTIVES. The goal of this report is to describe the collaborative formation of rational, practical, medical staff guidelines for the counseling and subsequent care of extremely early-gestation pregnancies and premature infants between 22 and 26 weeks. The purposes of the guidelines were to improve knowledge regarding neonatal outcomes, to provide consistency in periviability counseling, and to promote informed, supportive, responsible choices. METHODS. To formulate the guidelines, a 5-step… 

Figures and Tables from this paper

Counseling Pregnant Women Who May Deliver Extremely Premature Infants: Medical Care Guidelines, Family Choices, and Neonatal Outcomes

The experience implementing consensus medical staff guidelines used for counseling pregnant women threatening extremely premature birth between 22 and 26 weeks' postmenstrual age is described and an account of family preferences and the immediate outcome of their infants is given.

Joint periviability counseling between neonatology and obstetrics is a rare occurrence

JPC is recommended but infrequently performed, with both specialties interested in further collaboration to strengthen the counseling provided, and the majority of respondents in both groups reported that clinical duties posed a significant/great barrier to JPC.

Variation in the Treatment of Infants Born at the Borderline of Viability

The report documents the satisfaction of women whose perinatal counseling at Providence St Vincent Medical Center over 4 years was guided by the use of this counseling protocol, and recommends that other centers should (or at least could) adopt a similar approach to counseling women in comparable circumstances.

Counselling and management for anticipated extremely preterm birth.

All extremely preterm infants who are not resuscitated, or for whom resuscitation is not successful, must receive compassionate palliative care.

Attitudes of Obstetric and Pediatric Health Care Providers Toward Resuscitation of Infants Who Are Born at the Margins of Viability

The caregivers' recommendations seem to be based logically on the current literature regarding survival and morbidity that is experienced by infants who are born at the threshold of viability.

Periviable births: communication and counseling before delivery.

Given the urgency of the situation, the emotionally charged nature of the decision, and the relative unpredictability prior to presentation, this particular situation poses unique challenges for all involved and mandates the need to have carefully constructed guidelines and processes for care and counseling that meet the needs of all involved.

Evidence-Based Treatment Decisions for Extremely Preterm Newborns

Results of the cohort study by Bader et al, published in this issue of Pediatrics, are an important addition to the evidence base for decisions to give intensive care or comfort care to extremely preterm infants and are free of the referral biases in virtually all center-based studies.

National variability in neonatal resuscitation practices at the limit of viability.

OBJECTIVE Delivery room management of extremely premature infants is not subjected to professional regulations. In the United States, legal definitions of human viability and statutes regulating

Antenatal Counseling Regarding Resuscitation at an Extremely Low Gestational Age

Whenever resuscitation is considered an option, a qualified individual, preferably a neonatologist, should be involved and should be present in the delivery room to manage this complex situation.

Outcomes following periviable birth.

This review is presented in three segments: (1) important background concepts, (2) recent reports from regional geographically defined cohorts, and (3) prognosis research from the National Institutes



Use of an Outcome by Gestation Table for Extremely Premature Babies: A Cross-Sectional Survey of the Views of Parents, Neonatal Nurses and Perinatologists

An Outcome by Gestation Table (OGT) with information on survival, short-term complications plus treatments of the most recent cohort of babies born at different gestations from 23 to 28 weeks is constructed.

Characterising doctor-parent communication in counselling for impending preterm delivery

Serious deficiencies exist in parent-clinician encounters during extremely preterm labour and Concordance between parents and clinicians is poor and anxiety very high.

Outcomes of extremely-low-birth-weight infants.

Despite an increase in survival during 1990 to 1992, the neonatal and early childhood outcomes of the survivors were unchanged, and Physicians and parents anticipating the delivery of extremely low birth weight infants must be aware of these outcomes to make informed decisions as to the advisability of aggressive care at birth and thereafter.

The principles for family-centered neonatal care.

A group of articulate parents were assembled who were knowledgeable about the NICU from personal experience and from their work in support organizations, disability rights groups, and hospital ethics committees, because they wanted a group that would be sympathetic to the concerns of medical professionals.

Survival and follow‐up of infants born at 23 to 26 weeks of gestational age: Effects of surfactant therapy

It is concluded that surfactant use in extremely premature infants improves survival rates without increasing the proportion of impaired survivors.

A quantitative review of mortality and developmental disability in extremely premature newborns.

The prevalence of disabilities had not changed among EI or ES survivors with increasing survival, however, increasing survival of these infants has resulted in a steadily increasing prevalence of children with disabilities.