Effect of an Educational Presentation about Extremely Preterm Infants on Knowledge and Attitudes of Health Care Providers

2017 ◽  
Vol 34 (10) ◽  
pp. 0982-0989 ◽  
Author(s):  
Stefani Doucette ◽  
Brigitte Lemyre ◽  
Thierry Daboval ◽  
Sandra Dunn ◽  
Salwa Akiki ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Health Care Providers ◽  
Ethical Issues ◽  
Survival Rates ◽  
Care Providers ◽  
Perinatal Medicine ◽  
Knowledge And Attitudes ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Before And After

Objective To determine healthcare providers' knowledge (HCP) about survival rates of extremely preterm infants (EPI) and attitudes toward resuscitation before and after an educational presentation and, to examine the relationship between knowledge and attitudes toward resuscitation. Study Design Participants completed a survey before and after attending a presentation detailing evidence-based estimates of survival rates and surrounding ethical issues. Respondents included neonatologists, obstetricians, pediatricians, maternal-fetal medicine specialists, trainees in pediatrics, obstetrics, neonatal-perinatal medicine and neonatal and obstetrical nurses. Results In total, 166 participants attended an educational presentation and 130 participants completed both pre- and postsurveys (response rate 78%). Prepresentation, for all gestations, ≤ 50% of respondents correctly identified survival/intact survival rates. Postpresentation, correct responses regarding survival/intact survival rates ranged from 49 to 86% (p < 0.001) and attitudes shifted toward being more likely to resuscitate at all gestations regardless of parental wishes. There was a weak-to-modest relationship (Spearman's coefficient 0.24–0.40, p < 0.001–0.004) between knowledge responses and attitudes. Conclusion Attendance at an educational presentation did improve HCP knowledge about survival and long term outcomes for EPI, but HCP still underestimated survival and were not always willing to resuscitate in accordance with parental wishes. These findings may represent barriers to some experts' recommendation to use shared decision-making with parents when considering the resuscitation options for their EPI.

Neonatal Bioethical Perspectives: Practice Considerations

2013 ◽  
Vol 32 (3) ◽  
pp. 184-192 ◽  
Author(s):  
Raquel Pasarón
Keyword(s):  
Health Care Providers ◽  
Neonatal Intensive Care ◽  
Ethical Issues ◽  
Survival Rates ◽  
Health Impact ◽  
Care Providers ◽  
Educational Training ◽  
Modest Improvement ◽  
The Public ◽  
Technological Advances

Over the past 30 years, there has been a modest improvement in the survival rates of U.S. infants. The public health impact of associated economic and technological advances raises questions regarding neonatal care and end-of-life decisions for those caring for this population. Nurses have an obligation to remain abreast of neonatal ethical standards because they are intimately involved in caring for these patients. Therefore, the aim of this article is to (a) summarize the extant neonatal bioethical literature to appreciate the complex ethical issues that translate into practice challenges, (b) present a framework that guides the assessment of the benefits and burdens of neonatal intensive care in the clinical setting to solicit and provoke dialogue, and (c) provide examples that advocate for educational training for neonatal health care providers in support of ethically sound care to affected families and infants.

64 Association of 24-hour In-house Neonatologist Coverage with Outcomes of Extremely Preterm Infants

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e45-e46
Author(s):  
Anthony Debay ◽  
Prakesh Shah ◽  
Abhay Lodha ◽  
Sandesh Shivananda ◽  
Stephanie Redpath ◽  
...  
Keyword(s):  
Late Onset ◽  
Neurological Injury ◽  
Multivariable Logistic Regression Analysis ◽  
Care Providers ◽  
Chest Compressions ◽  
Perinatal Medicine ◽  
Major Morbidity ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Care Practices

Abstract Primary Subject area Neonatal-Perinatal Medicine Background Medical team composition at the delivery of high-risk neonates may contribute to better outcomes. The presence of 24-hour (h) in-house staff neonatologist (NN) may improve delivery room (DR) care practices and outcomes. Objectives To assess if 24-h in-house NN coverage is associated with better care practices and outcomes among inborn infants born &lt; 29 weeks GA. Design/Methods Cross-sectional cohort study of 2476 inborn infants born at 23-28 weeks gestation, admitted in 2014-2015 to Canadian Neonatal Network level 3 NICUs with a maternity unit that participated in a 2015 survey on NICU coverage. Exposures were classified using survey responses based on the most senior provider offering 24-h in-house coverage: NN, fellow, and no NN/fellow. Primary outcome was death and/or major morbidity (bronchopulmonary dysplasia, severe neurological injury, late-onset sepsis, necrotizing enterocolitis, retinopathy of prematurity). Multivariable logistic regression analysis was used to assess the association between exposures and outcomes and adjust for confounders with generalized estimating equations to account for clustering within each site. Results Among the 28 participating NICUs, most senior providers ensuring 24-h in-house coverage were NN (32%, 9/28), fellows (39%, 11/28), and no NN/fellow (29%, 8/28). Infants’ characteristics are shown in Table 1. No NN/fellow coverage and 24-h fellow coverage were associated with higher odds of infants receiving DR chest compressions or epinephrine compared to 24-h NN coverage (adjusted odds ratio [AOR] 4.72, 95% CI 2.12-10.6 and AOR 3.33, 95% CI 1.44-7.70, respectively) (Table 2). 24-h fellow coverage was associated with higher odds of normothermia (36.5°C-37.2°C) on admission (AOR 2.26, 95% CI 1.51-3.37) compared to 24-h NN coverage (Table 2). Rates of mortality or major morbidity did not differ significantly among the three groups: NN, 63% (249/395); fellow, 64% (1092/1700); no NN/fellow, 70% (266/381). Compared to 24-h NN coverage, 24-h fellow coverage was associated with lower odds of mortality (AOR 0.62, 95% CI, 0.43-0.88) (Table 2). Conclusion 24-h in-house NN coverage was associated with lower rates of DR chest compressions or epinephrine use; however, it was not associated with death and/or major morbidity. These results are from a survey linked cohort, and data on the actual presence of individuals in NICU/resuscitation is unknown. Future prospective research on care providers present in the NICU, and its impact on outcomes, is needed.

Higher incidence of retinopathy of prematurity in extremely preterm infants associated with improved survival rates

2020 ◽  
Vol 109 (10) ◽  
pp. 2033-2039 ◽  
Author(s):  
Aylin Taner ◽  
Senait Tekle ◽  
Torsten Hothorn ◽  
Mark Adams ◽  
Dirk Bassler ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Retinopathy Of Prematurity ◽  
Survival Rates ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

scholarly journals Viability and thresholds for treatment of extremely preterm infants: survey of UK neonatal professionals

2021 ◽  
pp. fetalneonatal-2020-321273
Author(s):  
Lydia Mietta Di Stefano ◽  
Katherine Wood ◽  
Helen Mactier ◽  
Sarah Elizabeth Bates ◽  
Dominic Wilkinson
Keyword(s):  
Preterm Infants ◽  
Nurse Practitioners ◽  
Active Treatment ◽  
Online Survey ◽  
Neonatal Resuscitation ◽  
Lower Threshold ◽  
Grey Zone ◽  
Perinatal Medicine ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

BackgroundDecisions about treatments for extremely preterm infants (EPIs) born in the ‘grey zone’ of viability can be ethically complex. This 2020 survey aimed to determine views of UK neonatal staff about thresholds for treatment of EPIs given a recently revised national Framework for Practice from the British Association of Perinatal Medicine.MethodsThe online survey requested participants indicate the lowest gestation at which they would be willing to offer active treatment and the highest gestation at which they would withhold active treatment of an EPI at parental request (their lower and upper thresholds). Relative risks were used to compare respondents’ views based on profession and neonatal unit designation. Further questions explored respondents’ conceptual understanding of viability.Results336 respondents included 167 consultants, 127 registrars/fellows and 42 advanced neonatal nurse practitioners (ANNPs). Respondents reported a median grey zone for neonatal resuscitation between 22+1 and 24+0 weeks’ gestation. Registrars/fellows were more likely to select a lower threshold at 22+0 weeks compared with consultants (Relative Risk (RR)=1.37 (95% CI 1.07 to 1.74)) and ANNPs (RR=2.68 (95% CI 1.42 to 5.06)). Those working in neonatal intensive care units compared with other units were also more likely to offer active treatment at 22+0 weeks (RR=1.86 (95% CI 1.18 to 2.94)). Most participants understood a fetus/newborn to be ‘viable’ if it was possible to survive, regardless of disability, with medical interventions accessible to the treating team.ConclusionCompared with previous studies, we found a shift in the reported lower threshold for resuscitation in the UK, with greater acceptance of active treatment for infants <23 weeks’ gestation.

How does the BAPM Framework for Practice on Perinatal Management of Extreme Preterm Birth Before 27 Weeks of Gestation impact delivery of Newborn Life Support? A Resuscitation Council UK response

2020 ◽  
Vol 105 (6) ◽  
pp. 672-674
Author(s):  
Joe Fawke ◽  
Robert J Tinnion ◽  
Victoria Monnelly ◽  
Sean B Ainsworth ◽  
Jonathan Cusack ◽  
...  
Keyword(s):  
Decision Making ◽  
Preterm Birth ◽  
Preterm Infants ◽  
Life Support ◽  
Perinatal Care ◽  
Perinatal Medicine ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Perinatal Management ◽  
The Uk

In October 2019, the British Association of Perinatal Medicine (BAPM) published a Framework1 and associated infographic2 for ‘Practice on Perinatal Management of Extreme Preterm Birth Before 27 Weeks of Gestation’. This outlined an approach, based on data from the UK and abroad, to assist clinicians in decision-making relating to perinatal care at ≤26+6 weeks gestation. Many frontline providers of delivery room care of extremely preterm infants will have completed a Resuscitation Council UK (RCUK) Newborn Life Support or Advanced Resuscitation of the Newborn Infant course. This RCUK response to the BAPM Framework highlights how this might impact on their approach.

scholarly journals Resuscitation of preterm infants in the Philippines: a national survey of resources and practice

2019 ◽  
Vol 105 (2) ◽  
pp. 209-214 ◽  
Author(s):  
Dean Hayden ◽  
Maria Esterlita Villanueva-Uy ◽  
Maria Katrina Mendoza ◽  
Dominic Wilkinson
Keyword(s):  
Preterm Infants ◽  
National Survey ◽  
Low Income ◽  
Survival Rates ◽  
The Philippines ◽  
Public Hospitals ◽  
National Guidelines ◽  
District Hospitals ◽  
Extremely Preterm ◽  
Extremely Preterm Infants

ObjectiveThere is a high incidence of preterm birth in low-income and middle-income countries where healthcare resources are often limited and may influence decision making. We aimed to explore the interplay between resource limitations and resuscitation practices for extremely preterm infants (EPIs) in neonatal intensive care units (NICUs) across the Philippines.MethodsWe conducted a national survey of NICUs in the Philippines. Institutions were classified according to sector (private/public), region and level. Respondents were asked about unit capacity, availability of ventilators and surfactant, resuscitation practices and estimated survival rates for EPIs of different gestational ages.ResultsRespondents from 103/228 hospitals completed the survey (response rate 45%). Public hospitals reported more commonly experiencing shortages of ventilators than private hospitals (85%vs23%, p<0.001). Surfactant was more likely to be available in city hospitals than regional/district hospitals (p<0.05) and in hospitals classified as Level III/IV than I/II (p<0.05). The financial capacity of parents was a major factor influencing treatment options. Survival rates for EPIs were estimated to be higher in private than public institutions. Resuscitation practice varied; active treatment was generally considered optional for EPIs from 25 weeks’ gestation and usually provided after 27–28 weeks’ gestation.ConclusionOur survey revealed considerable disparities in NICU resource availability between different types of hospitals in the Philippines. Variation was observed between hospitals as to when resuscitation would be provided for EPIs. National guidelines may generate greater consistency of care yet would need to reflect the variable context for decisions in the Philippines.

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