Prenatal counselling for congenital anomalies: a systematic review

Prenatal consultation: perspectives on training, relevance, and utilization among pediatric subspecialty program directors

OBJECTIVE

To characterize the experience and training of house officers in prenatal consultation, and to assess program directors' perceptions regarding adequacy of training, and relevance and utilization of prenatal consultation in their field.

STUDY DESIGN

An online survey was distributed to program directors of all ACGME-accredited programs in the United States in relevant pediatric subspecialties.

RESULTS

Ninety-five percent (142/150) of respondents agreed that prenatal consultation from their field can impact decision-making, yet 46% (69/149) believe their prenatal consult services are underutilized. The majority (56%, 86/152) reported no formal curriculum related to prenatal consultation in their program. Nine percent (14/150) rated their trainees as not adequately trained to perform competent prenatal consultation upon graduation; 35% (52/150) rated trainees as only "somewhat" competent.

CONCLUSION

Our study, the first of its kind, reveals widespread lack of formal training curricula, which may explain the finding that many graduating trainees are perceived as inadequately prepared to perform competent prenatal consultation.

Parental preferences for the first consultation for microtia

OBJECTIVES

The aim of our study was to investigate subjective information concerning parental experiences and preferences with regard to the initial information that is provided right after the birth of a child with microtia. The analysis of these data is intended to help professionals improve the way in which such conversations are conducted. As a result, future parents may feel better informed and, hence, better fit to cope with challenges they may encounter having a child with microtia.

METHODS

A self-administered questionnaire was sent to 106 parents and caretakers of children with microtia who visited the annual International Microtia and Atresia Conference in the Netherlands, May 2016.

RESULTS

Eighty-seven questionnaires were returned (response rate 82%). Results revealed that 26% of the participants did not receive any information about the condition in the perinatal period. Participants who did receive information right after birth were informed by pediatricians and otolaryngolosits in most of the cases. Plastic surgeons and maxillofacial surgeons were the less commonly serving specialties in this role. A majority of the participants experienced their informing consultation as either being "terrible", or "bad". Parents desired more information about all domains regarding microtia. Development, clothing and appearance, and psychology were believed to be the least important domains.

CONCLUSIONS

Parents are dissatisfied with several aspects of the initial information that is provided right after the birth of a child with microtia. We believe that there is a need for correct information and patient- and family centered care administered by multiple disciplines.

Psychological Effect of Prenatal Diagnosis of Cleft Lip and Palate: A Systematic Review

Introduction and Background:

Cleft lip and/or palate is the most common congenital craniofacial anomaly. Prenatal diagnosis of the craniofacial anomalies is possible with the advent of newer imaging modalities. The identification of the defect at an early stage in the pregnancy helps the parents to be well informed and counseled regarding the treatment possibilities and outcomes of cleft lip and palate (CLP) treatment.

Objectives:

To analyze the psychological effects of prenatal diagnosis of CLP on the parents.

Materials and Methods:

PubMed, Cochrane, and Google Scholar searches were made with search strings “prenatal diagnosis cleft lip palate,” “antenatal diagnosis,” “anomaly scan,” “psychological effect cleft lip palate,” and “prenatal counseling cleft lip palate.” Of the results obtained, studies which evaluated the psychological aspects of parents of cleft children were further included in the study.

Results:

Electronic search yielded 500 articles after duplication removal. Forty studies concentrated on the results of the scan and their implications predominantly in the diagnosis and management of cleft and other related abnormalities. Eight studies discussed the effects of prenatal diagnosis and counseling on the parents.

Conclusion:

Prenatal diagnosis enables appropriate and timely counseling of the parents by the cleft team and helps instill a sense of preparedness for the family which highly improves the quality of treatment received by the child enabling a near-to-normal quality and standard of life.

Caring for infants with posterior urethral valves: A qualitative study of parents' experiences

This study aimed to explore the perspectives and experiences of parents caring for an infant with posterior urethral valves (PUVs). Eight parents participated in a semi-structured, individual telephone interview, with qualitative data collected and analysed thematically using NVivo11 software. Two main themes emerged as interconnecting aspects of parents' experiences: (1) trying to face the challenges and (2) learning to cope. Parents felt challenged by the need to attend to their child's medical care, while developing a bond with their baby, trying to maintain positivity for their child's future and managing the impact of the condition on their family. Nevertheless, parents developed strategies to cope with these challenges, such as seeking support, normalizing the experience and focusing on the positives. This preliminary understanding of parents' experiences provides direction for improving care pathways for infants with PUV and their parents as well as guides further research in this previously unexplored area.