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Variations among US hospitals in counseling practices regarding prematurely born infants

Abstract

Objective:

We studied several counselor-independent elements of prenatal counseling regarding prematurely born infants. Elements studied include: indications to offer counseling, clinical settings in which counseling is offered, personnel assigned to counsel, availability of tools to assist counseling and post-counseling documentation requirements.

Method:

As the study aimed to explore system-based practices and not counselor-based practices, we surveyed Neonatal Intensive Care Unit medical directors.

Result:

Responses were received from 352 hospitals (53%) in 47 states. Analysis was based on responses from the 337 hospitals that routinely counseled women anticipating a premature birth. In 299 (90%) hospitals, counseling was primarily performed by neonatal professionals. Premature labor was the most common indication to offer counseling; however, in 54 hospitals most counseling was offered before labor and based on maternal risk factors for preterm delivery. In nearly all (99.7%) hospitals information was provided verbally and face-to-face; a third of the hospitals also provided written information. For non-English-speaking Hispanic patients, 208 (62%) of the hospitals had certified hospital-based Spanish interpreters. Five (1%) hospitals provided specialized training to the designated prenatal counselors. The upper gestational age eligible for counseling at all 337 hospitals included 33 weeks; in 134 hospitals, gestational age of <23 weeks was not eligible for counseling.

Conclusion:

Antenatal parental counseling for premature delivery is a widely practiced intervention with substantial system-based variability in execution. Interventions and strategies known to improve overall counseling effectiveness are not commonly utilized. We speculate that guidelines and tool-kits supported by Pediatric and Obstetric professional organizations may help improve system-based practices.

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References

  1. MacDonald H American Academy of P, Committee on Fetus and N. Perinatal care at the threshold of viability. Pediatrics 2002; 110 (5): 1024–1027.

    Article  Google Scholar 

  2. American College of Obstetricians and,Gynecologists. ACOG Practice Bulletin: Clinical Management Guidelines for Obstetrcian-Gynecologists: Number 38, September 2002. Perinatal care at the threshold of viability. Obstetrics & Gynecology 2002; 100 (3): 617–624.

    Google Scholar 

  3. Kumar D, Sanders L, Perrin EM, Lokker N, Patterson B, Gunn V et al. Parental understanding of infant health information: health literacy, numeracy, and the Parental Health Literacy Activities Test (PHLAT). Acad Pediatr 2010; 10 (5): 309–316.

    Article  Google Scholar 

  4. Yin HS, Johnson M, Mendelsohn AL, Abrams MA, Sanders LM, Dreyer BP . The health literacy of parents in the United States: a nationally representative study. Pediatrics 2009; 124 (Supplement_3): S289–S298.

    Article  Google Scholar 

  5. Ling ZJ, Lian WB, Ho SK, Yeo CL . Parental knowledge of prematurity and related issues. Singapore Med J 2009; 50 (3): 270–277.

    CAS  Google Scholar 

  6. Massett HA, Greenup M, Ryan CE, Staples DA, Green NS, Maibach EW . Public perceptions about prematurity: a national survey. Am J Prev Med 2003; 24 (2): 120–127.

    Article  Google Scholar 

  7. Batton DG Committee on Fetus and Newborn,. Antenatal counseling regarding resuscitation at an extremely low gestational age. Pediatrics 2009; 124 (1): 422–427.

    Article  Google Scholar 

  8. Epstein RM, Franks P, Fiscella K, Shields CG, Meldrum SC, Kravitz RL et al. Measuring patient-centered communication in patient–physician consultations: theoretical and practical issues. Soc Sci Med 2005; 61 (7): 1516–1528.

    Article  Google Scholar 

  9. Lahaut VMHCJ, Jansen HAM, van de Mheen D, Garretsen HFL, Verdurmen JEE, van Dijk A . Estimating non-response bias in a survey on alcohol consumption: comparison of response waves. Alcohol Alcoholism 2003; 38 (2): 128–134.

    Article  Google Scholar 

  10. Melamed N, Klinger G, Tenenbaum-Gavish K, Herscovici T, Linder N, Hod M et al. Short-term neonatal outcome in low-risk, spontaneous, singleton, late preterm deliveries. Obstet Gynecol 2009; 114 (2 Part 1): 253–260.

    Article  Google Scholar 

  11. Marret S, Ancel P, Marpeau L, Marchand LM, Pierrat V, Larroque B et al. Neonatal and 5-year outcomes after birth at 30-34 weeks of gestation. Obstet Gynecol 2007; 110 (1): 72–80.

    Article  Google Scholar 

  12. Chyi LJ, Lee HC, Hintz SR, Gould JB, Sutcliffe TL . School outcomes of late preterm infants: special needs and challenges for infants born at 32 to 36 weeks gestation. J Pediatr 2008; 153 (1): 25–31.

    Article  Google Scholar 

  13. Lindstrom K, Lindblad F, Hjern A . Psychiatric morbidity in adolescents and young adults born preterm: a Swedish National Cohort Study. Pediatrics 2009; 123 (1): e47–e53.

    Article  Google Scholar 

  14. Pridham KF . Anticipatory guidance of parents of new infants: potential contribution of the internal working model construct. Image J Nurs Sch 1993; 25 (1): 49–56.

    Article  CAS  Google Scholar 

  15. Swan HD, Borshoff DC . Informed consent-recall of risk information following epidural analgesia in labour. Anaesth Intensive Care 1994; 22 (2): 139–141.

    Article  CAS  Google Scholar 

  16. Ghia N, Spong CY, Starbuck VN, Scialli AR, Ghidini A . Magnesium sulfate therapy affects attention and working memory in patients undergoing preterm labor. Obstet Gynecol 2000; 183 (4): 940–944.

    CAS  Google Scholar 

  17. Zupancic JAF, Kirpalani H, Barrett J, Stewart S, Gafni A, Streiner D et al. Characterising doctor-parent communication in counselling for impending preterm delivery. Arch Dis Child Fetal Neonatal Ed 2002; 87 (2): F113–F117.

    Article  CAS  Google Scholar 

  18. Behrman RE, Butler AS . Executive Summary of Institute of Medicine of the National Academies. Preterm Birth: Causes, Consequences, and Prevention 2006.

  19. Mercer BM, Goldenberg RL, Moawad AH, Meis PJ, Iams JD, Das AF et al. The Preterm Prediction Study: Effect of gestational age and cause of preterm birth on subsequent obstetric outcome. Obstet Gynecol 1999; 181 (5): 1216–1221.

    CAS  Google Scholar 

  20. Freak-Poli R, Chan A, Tucker G, Street J . Previous abortion and risk of pre-term birth: a population study. J Matern Fetal Neonatal Med 2009; 22 (1): 1–7.

    Article  Google Scholar 

  21. Goldenberg RL, Culhane JF, Iams JD, Romero R . Epidemiology and causes of preterm birth. The Lancet 2008; 371 (9606): 75–84.

    Article  Google Scholar 

  22. Boss RD, Hutton N, Donohue PK, Arnold RM . Neonatologist training to guide family decision making for critically Ill infants. Arch Pediatr Adolesc Med 2009; 163 (9): 783–788.

    Article  Google Scholar 

  23. Powell MR, Kim UO, Weisgerber MC, Simpson PM, Nugent M, Basir MA . Readiness of obstetric professionals to inform parents regarding potential outcome of premature infants. J Obstet Gynaecol 2012; 32 (4): 326–331.

    Article  CAS  Google Scholar 

  24. Griswold KJ, Fanaroff JM . An evidence-based overview of prenatal consultation with a focus on infants born at the limits of viability. Pediatrics 2010; 125 (4): e931–e937.

    Article  Google Scholar 

  25. Muthusamy AD, Leuthner S, Gaebler-Uhing C, Hoffmann RG, Li S, Basir MA . Supplemental written information improves prenatal counseling: a randomized trial. Pediatrics 2012; 129 (5): e1269–e1274.

    Article  Google Scholar 

  26. Kakkilaya V, Groome LJ, Platt D, Kurepa D, Pramanik A, Caldito G et al. Use of a visual aid to improve counseling at the threshold of viability. Pediatrics 2011; 128 (6): e1511–e1519.

    Article  Google Scholar 

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Correspondence to M A Basir.

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Supplementary Information accompanies the paper on the Journal of Perinatology website

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Mehrotra, A., Lagatta, J., Simpson, P. et al. Variations among US hospitals in counseling practices regarding prematurely born infants. J Perinatol 33, 509–513 (2013). https://doi.org/10.1038/jp.2012.172

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