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Neonatologists’ preferences regarding guidelines for periviable deliveries: do we really know what we want?

Journal of Perinatology volume 39, pages 445–452 (2019)Cite this article

Subjects

Abstract

Objective

To examine neonatology providers’ preferences regarding periviability guidelines.

Study design

An online cross-sectional survey of American Academy of Pediatrics Section on Neonatal-Perinatal Medicine members.

Results

Most of the 480 respondents desired standardized guidelines for upper (85%) and lower (87%) gestational age limits for offering resuscitation and comfort care. Standardization was most to least frequently desired at the national, institutional, and regional levels. Within scenarios involving parents’ preferences conflicting with institutional guidelines, respondents chose parent-preferred options more often (66 vs. 34%). Overall, resuscitation (48%) versus comfort care (52%) were nearly equally chosen. In emergency scenarios, more versus less experienced respondents favored parent-preferred options over guidelines (55 vs. 46%, p = 0.003) and chose resuscitation over comfort care (50 vs. 36%, p < 0.001).

Conclusions

Neonatal providers desire age-based periviability guidelines, but do not agree on the level of standardization. Such limits may be insufficient to guide clinical practice. Policies should include processes that direct providers through fair transparent decision-making.

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Acknowledgements

We thank our colleagues at the University of Washington and Evanston Hospital for improving our survey through their pilot feedback. Data management was possible through grant support for REDCap from NorthShore University HealthSystem.

Funding

Data management was possible through grant support for REDCap from NorthShore University HealthSystem.

Author contributions

JAK and DMF developed the concept for the project, designed the survey, analyzed the data, and wrote the manuscript together.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Madigan Army Medical Center, Tacoma, WA, USA

    Jeanne A. Krick

  2. Division of Neonatology, Department of Pediatrics, Evanston Hospital, NorthShore University HealthSystem, Evanston, IL, USA

    Dalia M. Feltman

  3. Pritzker School of Medicine, University of Chicago, Chicago, IL, USA

    Dalia M. Feltman

Authors
  1. Jeanne A. Krick
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  2. Dalia M. Feltman
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Correspondence to Jeanne A. Krick.

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Krick, J.A., Feltman, D.M. Neonatologists’ preferences regarding guidelines for periviable deliveries: do we really know what we want?. J Perinatol 39, 445–452 (2019). https://doi.org/10.1038/s41372-019-0313-1

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