When should intensive care be provided for the extremely preterm infants born at the margin of viability? A survey of Australasian parents and clinicians
| Autor: | Alvin Hock Kuan Tan, Antonia W. Shand, Srinivas Bolisetty, Sharon S.W. Chow, Robert Guaran, Melinda Cruz, Tim Schindler, Renate E. Le Marsney, Kei Lui |
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| Rok vydání: | 2020 |
| Předmět: |
Parents
medicine.medical_specialty Resuscitation Neonatal intensive care unit Critical Care Decision Making 03 medical and health sciences 0302 clinical medicine Pregnancy Premature baby Interquartile range Intensive Care Units Neonatal 030225 pediatrics Intensive care Risk of mortality Humans Medicine 030212 general & internal medicine Extremely premature business.industry Extremely preterm Australia Infant Newborn Infant Infant Extremely Premature Family medicine Pediatrics Perinatology and Child Health Intensive Care Neonatal Female business |
| Zdroj: | Journal of Paediatrics and Child Health. 57:52-57 |
| ISSN: | 1440-1754 1034-4810 |
| DOI: | 10.1111/jpc.15115 |
| Popis: | Aim This study aimed to explore clinician and parent opinions of risk limits on resuscitation and intensive care (IC) for extremely premature infants born at the margin of viability. Methods Two anonymous on-line surveys were conducted from August 2016 to January 2017. Survey participants were: (i) clinicians affiliated with neonatal intensive care units in Australia; and (ii) parents or individuals who expressed interest in premature babies through the Facebook page of Miracle Babies Foundation. Results A total of 961 responses were received. Among 204 clinicians, 52% were neonatologists, 22% obstetricians, 20% neonatal intensive care unit nurses and 4% were midwives. Among 757 parents, 98% had a premature baby. Only 75% of clinicians responded to the risk limits questions. Median mortality risk above which they would not recommend resuscitation/IC was 70% (interquartile range (IQR) 50-80%); major disability risk in survivors 60% (IQR 50-75%); and composite risk of mortality and major disability 70% (IQR 50-80%). All parents answered the risk limit questions. The median mortality risk for not planning resuscitation was 90% (IQR 60-90%); major disability risk in survivors 50% (IQR 30-90%); and composite risk 90% (IQR 50-90%). Most clinicians (82%) stated that decisions should be guided by parent opinions if there are uncertainties. Parents had varying perception of previous counselling, and 57% stated that both their viewpoint and doctor's predicted risk influenced their decision-making. Conclusions Clinicians and parents had different views on mortality and major disability risks when deciding on resuscitation/neonatal IC treatment. When there was uncertainty, both agreed on working together. |
| Databáze: | OpenAIRE |
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