1
|
LoRe D, Groden CM, Schuh AR, Holmes C, Ostilla L, Vogel MM, Murray PD, Yamasato K, Tonismae T, Anani UE, Henner N, Famuyide M, Leuthner SR, Laventhal N, Andrews BL, Tucker Edmonds BM, Brennan KG, Feltman DM. Variability of Care Practices for Extremely Early Deliveries. Pediatrics 2024; 154:e2023065521. [PMID: 39129496 PMCID: PMC11350101 DOI: 10.1542/peds.2023-065521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 08/13/2024] Open
Abstract
OBJECTIVES Assess temporal changes, intercenter variability, and birthing person (BP) factors relating to interventions for extremely early deliveries. METHODS Retrospective study of BPs and newborns delivered from 22-24 completed weeks at 13 US centers from 2011-2020. Rates of neonatology consultation, antenatal corticosteroids, cesarean delivery, live birth, attempted resuscitation (AR), and survival were assessed by epoch, center, and gestational age. RESULTS 2028 BPs delivering 2327 newborns were included. Rates increased in epoch 2-at 22 weeks: neonatology consultation (37.6 vs 64.3%, P < .001), corticosteroids (11.4 vs 29.5%, P < .001), live birth (66.2 vs 78.6%, P < .001), AR (20.1 vs 36.9%, P < .001), overall survival (3.0 vs 8.9%, P = .005); and at 23 weeks: neonatology consultation (73.0 vs 80.5%, P = .02), corticosteroids (63.7 vs 83.7%, P < .001), cesarean delivery (28.0 vs 44.7%, P < .001), live birth (88.1 vs 95.1%, P < .001), AR (67.7 vs 85.2%, P < .001), survival (28.8 vs 41.6%, P < .001). Over time, intercenter variability increased at 22 weeks for corticosteroids (interquartile range 18.0 vs 42.0, P = .014) and decreased at 23 for neonatology consultation (interquartile range 23.0 vs 5.2, P = .045). In BP-level multivariate analysis, AR was associated with increasing gestational age and birth weight, Black BP race, previous premature delivery, and delivery center. CONCLUSIONS Intervention rates for extremely early newborns increased and intercenter variability changed over time. In BP-level analysis, factors significantly associated with AR included Black BP race, previous premature delivery, and center.
Collapse
Affiliation(s)
- Danielle LoRe
- Department of Pediatrics, Columbia University, New York, New York
| | | | - Allison R. Schuh
- Department of Pediatrics, University of Chicago, Chicago, Illinois
| | - Chondraah Holmes
- Department of Pediatrics, Children’s Wisconsin, Milwaukee, Wisconsin
| | - Lorena Ostilla
- Department of Pediatrics, Lurie Children’s Hospital, Chicago, Illinois
| | - Maggie M. Vogel
- Department of Pediatrics, Advocate Christ Hospital, Oak Lawn, Illinois
| | - Peter D. Murray
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Kelly Yamasato
- Department of Obstetrics, Gynecology, and Women’s Health, University of Hawaii, Honolulu, Hawaii
| | | | - Uchenna E. Anani
- Department of Pediatrics, Vanderbilt University, Nashville, Tennessee
| | - Natalia Henner
- Department of Pediatrics, Lurie Children’s Hospital, Chicago, Illinois
| | - Mobolaji Famuyide
- Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | | | - Naomi Laventhal
- Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Dalia M. Feltman
- Division of Neonatology, Department of Pediatrics, NorthShore University HealthSystem Evanston Hospital, Evanston, Illinois
| | | |
Collapse
|
2
|
Kim NR, Lee JY, Park J, Lau ST. Ecological predictors of cultural competence among nurses in the neonatal intensive care unit: A cross-sectional descriptive study. Nurs Health Sci 2024; 26:e13115. [PMID: 38605597 DOI: 10.1111/nhs.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/26/2024] [Accepted: 03/16/2024] [Indexed: 04/13/2024]
Abstract
Active migration and globalization have led to increased opportunities for critical care nurses to care for patients from diverse racial and cultural backgrounds. This study thus aimed to identify the individual, interpersonal, and organizational factors affecting cultural competence levels among neonatal intensive care unit (NICU) nurses based on an ecological model. This was a cross-sectional descriptive study that included 135 NICU nurses in South Korea. A hierarchical multiple linear regression analysis was conducted using the proposed ecological model, and a regression model for each of the four subdomains of cultural competence was constructed and compared. NICU nurses' cultural competencies were influenced not only by the "necessity of multicultural education" and "ethnocultural empathy" at the individual level but by the "hospital's readiness and support for cultural competencies" at the organizational level. To promote the cultural competence of nurses in critical care settings, environmental and organizational support should be improved, along with developing strategies that focus on nurses' individual characteristics. It is also necessary to investigate the "intersectionality" of the effects of individual and environmental factors on cultural competence.
Collapse
Affiliation(s)
| | - Ja-Yin Lee
- College of Nursing, Yonsei University, Seoul, South Korea
| | - Jiyoung Park
- College of Nursing, Institute for Health Science Research, Inje University, Busan, South Korea
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
3
|
de Boer A, De Proost L, de Vries M, Hogeveen M, Verweij EJTJ, Geurtzen R. Perspectives of extremely prematurely born adults on what to consider in prenatal decision-making: a qualitative focus group study. Arch Dis Child Fetal Neonatal Ed 2024; 109:196-201. [PMID: 37726159 DOI: 10.1136/archdischild-2023-325997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/05/2023] [Indexed: 09/21/2023]
Abstract
OBJECTIVE A shared decision-making (SDM) approach is recommended for prenatal decisions at the limit of viability, with a guiding role for parental values. People born extremely premature experience the consequences of the decision made, but information about their perspectives on prenatal decisions is lacking. Therefore, this study aims to describe their perspectives on what is important in decision-making at the limit of viability. DESIGN Semi-structured focus group discussions were conducted, recorded and transcribed verbatim. The data were independently analysed by two researchers in Atlas.ti. RESULTS Four focus groups were conducted in the Netherlands, with five to six participants each, born between 240/7 and 300/7 weeks gestation in the period between 1965 and 2002. Considering their personal life experiences and how their extremely premature birth affected their families, the participants reflected on decision-making at the limit of viability. Various considerations were discussed and summarised into the following themes: anticipated parental regret, the wish to look at the baby directly after birth, to give the infant a chance at survival, quality of life, long-term outcomes for the infant and the family, and religious or spiritual considerations. CONCLUSIONS Insights into the perspectives of adults born extremely premature deepened our understanding of values considered in decision-making at the limit of viability. Results point out the need for a more individualised prediction of the prognosis and more extensive information on the lifelong impact of an extremely premature birth on both the infant and the family. This could help future parents and healthcare professionals in value-laden decision-making.
Collapse
Affiliation(s)
- Angret de Boer
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lien De Proost
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke de Vries
- Institute for Computing and Information Sciences (iCIS), Radboud University, Nijmegen, The Netherlands
| | - Marije Hogeveen
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E J T Joanne Verweij
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rosa Geurtzen
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
4
|
Vidiella-Martin J, Been JV. Maternal Migration Background and Mortality Among Infants Born Extremely Preterm. JAMA Netw Open 2023; 6:e2347444. [PMID: 38091041 PMCID: PMC10719757 DOI: 10.1001/jamanetworkopen.2023.47444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/30/2023] [Indexed: 12/17/2023] Open
Abstract
Importance Extremely preterm infants require care provided in neonatal intensive care units (NICUs) to survive. In the Netherlands, a decision is made regarding active treatment between 24 weeks 0 days and 25 weeks 6 days after consultation with the parents. Objective To investigate the association between maternal migration background and admissions to NICUs and mortality within the first year among extremely preterm infants. Design, Setting, and Participants This cross-sectional study linked data of registered births in the Netherlands with household-level income tax records and municipality and mortality registers. Eligible participants were households with live births at 24 weeks 0 days to 25 weeks 6 days gestation between January 1, 2010, and December 31, 2017. Data linkage and analysis was performed from March 1, 2020, to June 30, 2023. Exposure Maternal migration background, defined as no migration background vs first- or second-generation migrant mother. Main Outcomes and Measures Admissions to NICUs and mortality within the first week, month, and year of life. Logistic regressions were estimated adjusted for year of birth, maternal age, parity, household income, sex, gestational age, multiple births, and small for gestational age. NICU-specific fixed effects were also included. Results Among 1405 live births (768 male [54.7%], 546 [38.9%] with maternal migration background), 1243 (88.5%) were admitted to the NICU; 490 of 546 infants (89.7%) born to mothers with a migration background vs 753 of 859 infants (87.7%) born to mothers with no migration background were admitted to NICU (fully adjusted RR, 1.03; 95% CI, 0.99-1.08). A total of 652 live-born infants (46.4%) died within the first year of life. In the fully adjusted model, infants born to mothers with a migration background had lower risk of mortality within the first week (RR, 0.81; 95% CI, 0.66-0.99), month (RR, 0.84; 95% CI, 0.72-0.97), and year of life (RR, 0.85; 95% CI, 0.75-0.96) compared with infants born to mothers with no migration background. Conclusions In this nationally representative cross-sectional study, infants born to mothers with a migration background at 24 weeks 0 days to 25 weeks 6 days of gestation in the Netherlands had lower risk of mortality within the first year of life than those born to mothers with no migration background, a result that was unlikely to be explained by mothers from different migration backgrounds attending different NICUs or differential preferences for active obstetric management across migration backgrounds. Further research is needed to understand the underlying mechanisms driving these disparities, including parental preferences for active care of extremely preterm infants.
Collapse
Affiliation(s)
- Joaquim Vidiella-Martin
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
- Erasmus School of Economics, Tinbergen Institute and Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - Jasper V. Been
- Division of Neonatology, Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| |
Collapse
|
5
|
de Boer A, de Vries M, Berken DJ, van Dam H, Verweij EJ, Hogeveen M, Geurtzen R. A scoping review of parental values during prenatal decisions about treatment options after extremely premature birth. Acta Paediatr 2023; 112:911-918. [PMID: 36710530 DOI: 10.1111/apa.16690] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023]
Abstract
AIM To describe what is known in the literature about parental perspectives in making prenatal decisions regarding treatment after birth at the limit of viability, as a better understanding of parental values can help professionals support parents as they decide. METHODS PubMed, Cochrane, Embase, CINAHL, PsycINFO and Web of Science were searched to identify relevant literature from 1 January 2010 to 22 April 2022 on parental decision making. Data were extracted from selected studies and organised into themes. The final themes were formed through collaboration with the parents of a premature infant born at 24 weeks. RESULTS Of the 15,159 papers examined, 17 were included. Parental perspectives were described in terms of long-term outcomes for the infant, survival, protection against the burden of neonatal treatment, long-term impact on the family, religion and spiritual beliefs, to do everything possible, hope, sense of responsibility, wanting the best, doing what is right, giving a chance and the influence of experience. CONCLUSION The extracted parental perspectives show the complexity of these decisions. Some perspectives were clear, but others were multi-interpretable. Increasing the understanding of common parental perspectives can help improve shared prenatal decisions and lead to further improvement and personalisation of the process.
Collapse
Affiliation(s)
- Angret de Boer
- Department of Neonatology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands.,Department of Obstetrics & Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marieke de Vries
- Institute for Computing and Information Sciences (iCIS), Radboud University, Nijmegen, The Netherlands
| | - Dirk-Jan Berken
- Parents of an extremely premature infant born at 24 week gestation, The Netherlands
| | - Hiske van Dam
- Parents of an extremely premature infant born at 24 week gestation, The Netherlands
| | - E Joanne Verweij
- Department of Obstetrics & Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marije Hogeveen
- Department of Neonatology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Rosa Geurtzen
- Department of Neonatology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| |
Collapse
|
6
|
Swanson K, Kramer K, Jain S, Rogers EE, Rosenstein MG. Patient Decisions Regarding Fetal Monitoring in the Periviable Period and Perinatal and Maternal Outcomes. Am J Perinatol 2022; 39:1383-1388. [PMID: 35373308 DOI: 10.1055/a-1815-2000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE Management of delivery at periviable gestation requires complex counseling and decision making, including difficult choices about monitoring and potential cesarean delivery (CD) for fetal benefit. Our objective was to characterize decisions that patients make regarding fetal monitoring and potential CD for fetal benefit when delivering in the periviable period, and associations with perinatal and obstetric outcomes. We hypothesize that a significant number of patients forgo monitoring and potential CD for fetal benefit in the periviable period when offered the opportunity to do so. STUDY DESIGN Retrospective cohort study of nonanomalous singleton pregnancies delivering between 230/7 and 256/7 weeks at a tertiary care center from 2015 to 2020 as based on our institutional clinical practice. Since 2015, these patients are offered the ability to accept or decline fetal monitoring, potential CD for fetal benefit, and active resuscitation of a liveborn neonate. The frequency of patients desiring potential CD for fetal benefit was identified, and associations with CD and intrapartum demise were analyzed. RESULTS Fifty subjects were included. Seventy-eight percent (n = 39) desired monitoring and potential CD for fetal benefit, and 84% (n = 42) desired resuscitation if the neonate was born alive. This varied by gestational age: 55% (6/11) of patients delivering between 230/7 and 236/7 weeks desired fetal monitoring and potential CD for fetal benefit, while 90% (19/21) of patients delivering between 250/7 and 256/7 weeks desired fetal monitoring and potential CD for fetal benefit (p = 0.02). Sixty-nine percent of pregnancies in which potential CD for fetal benefit was desired resulted in CD (27/39), of which 85% were classical (23/27). Intrapartum fetal demise occurred in 45% (5/11) of pregnancies in which monitoring was not performed. CONCLUSION While a majority of patients delivering between 230/7 and 256/7 weeks desired monitoring and potential CD for fetal benefit, this varied significantly by gestational age. The decision to perform monitoring and potential CD for fetal benefit was associated with a high frequency of CD, while the decision to forgo monitoring was associated with high frequency of intrapartum demise. KEY POINTS · Patients desires vary in the setting of periviable delivery.. · Periviable monitoring is associated with cesarean delivery.. · Forgoing monitoring is associated with intrapartum demise..
Collapse
Affiliation(s)
- Kate Swanson
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco.,Division of Medical Genetics, Department of Pediatrics, University of California, San Francisco
| | - Katelin Kramer
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco
| | - Samhita Jain
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco
| | - Elizabeth E Rogers
- Division of Neonatology, Department of Pediatrics, University of California, San Francisco
| | - Melissa G Rosenstein
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| |
Collapse
|
7
|
Venkatesh KK, Lynch CD, Costantine MM, Backes CH, Slaughter JL, Frey HA, Huang X, Landon MB, Klebanoff MA, Khan SS, Grobman WA. Trends in Active Treatment of Live-born Neonates Between 22 Weeks 0 Days and 25 Weeks 6 Days by Gestational Age and Maternal Race and Ethnicity in the US, 2014 to 2020. JAMA 2022; 328:652-662. [PMID: 35972487 PMCID: PMC9382444 DOI: 10.1001/jama.2022.12841] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Birth in the periviable period between 22 weeks 0 days and 25 weeks 6 days' gestation is a major source of neonatal morbidity and mortality, and the decision to initiate active life-saving treatment is challenging. OBJECTIVE To assess whether the frequency of active treatment among live-born neonates in the periviable period has changed over time and whether active treatment differed by gestational age at birth and race and ethnicity. DESIGN, SETTING, AND PARTICIPANTS Serial cross-sectional descriptive study using National Center for Health Statistics natality data from 2014 to 2020 for 61 908 singleton live births without clinical anomalies between 22 weeks 0 days and 25 weeks 6 days in the US. EXPOSURES Year of delivery, gestational age at birth, and race and ethnicity of the pregnant individual, stratified as non-Hispanic Asian/Pacific Islander, non-Hispanic Black, Hispanic/Latina, and non-Hispanic White. MAIN OUTCOMES AND MEASURES Active treatment, determined by whether there was an attempt to treat the neonate and defined as a composite of surfactant therapy, immediate assisted ventilation at birth, assisted ventilation more than 6 hours in duration, and/or antibiotic therapy. Frequencies, mean annual percent change (APC), and adjusted risk ratios (aRRs) were estimated. RESULTS Of 26 986 716 live births, 61 908 (0.2%) were periviable live births included in this study: 5% were Asian/Pacific Islander, 37% Black, 24% Hispanic, and 34% White; and 14% were born at 22 weeks, 21% at 23 weeks, 30% at 24 weeks, and 34% at 25 weeks. Fifty-two percent of neonates received active treatment. From 2014 to 2020, the overall frequency (mean APC per year) of active treatment increased significantly (3.9% [95% CI, 3.0% to 4.9%]), as well as among all racial and ethnic subgroups (Asian/Pacific Islander: 3.4% [95% CI, 0.8% to 6.0%]); Black: 4.7% [95% CI, 3.4% to 5.9%]; Hispanic: 4.7% [95% CI, 3.4% to 5.9%]; and White: 3.1% [95% CI, 1.1% to 4.4%]) and among each gestational age range (22 weeks: 14.4% [95% CI, 11.1% to 17.7%] and 25 weeks: 2.9% [95% CI, 1.5% to 4.2%]). Compared with neonates born to White individuals (57.0%), neonates born to Asian/Pacific Islander (46.2%; risk difference [RD], -10.81 [95% CI, -12.75 to -8.88]; aRR, 0.82 [95% CI, [0.79-0.86]), Black (51.6%; RD, -5.42 [95% CI, -6.36 to -4.50]; aRR, 0.90 [95% CI, 0.89 to 0.92]), and Hispanic (48.0%; RD, -9.03 [95% CI, -10.07 to -7.99]; aRR, 0.83 [95% CI, 0.81 to 0.85]) individuals were significantly less likely to receive active treatment. CONCLUSIONS AND RELEVANCE From 2014 to 2020 in the US, the frequency of active treatment among neonates born alive between 22 weeks 0 days and 25 weeks 6 days significantly increased, and there were differences in rates of active treatment by race and ethnicity.
Collapse
MESH Headings
- Clinical Decision-Making
- Cross-Sectional Studies
- Ethnicity/statistics & numerical data
- Female
- Fetal Viability
- Gestational Age
- Humans
- Infant, Extremely Premature
- Infant, Newborn
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/ethnology
- Infant, Premature, Diseases/therapy
- Intensive Care, Neonatal/methods
- Intensive Care, Neonatal/statistics & numerical data
- Intensive Care, Neonatal/trends
- Live Birth/epidemiology
- Live Birth/ethnology
- Patient Care/methods
- Patient Care/statistics & numerical data
- Patient Care/trends
- Pregnancy
- Retrospective Studies
- United States/epidemiology
Collapse
Affiliation(s)
- Kartik K. Venkatesh
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Courtney D. Lynch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Maged M. Costantine
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Carl H. Backes
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Jonathan L. Slaughter
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
- Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus
| | - Heather A. Frey
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Xiaoning Huang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mark B. Landon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| | - Mark A. Klebanoff
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio
| | - Sadiya S. Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus
| |
Collapse
|
8
|
Rizvydeen S, Feltman DM. What Happened to Dad? The Complexity of Paternal Trauma and Ethical Care. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:74-76. [PMID: 35475960 DOI: 10.1080/15265161.2022.2055213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
| | - Dalia M Feltman
- NorthShore University HealthSystem
- University of Chicago Pritzker School of Medicine
| |
Collapse
|
9
|
Abstract
Decision-making at extreme prematurity remains ethically and practically challenging and can result in parental and clinician distress. It is vital that clinicians learn the necessary skills integral to counseling and decision-making with families in these situations. A pedagogical approach to teaching counseling should incorporate adult learning theory, emphasize multidisciplinary team in-situ simulation that links to counseling clinicians' daily practice, and includes critical reflection, debriefing, and program assessment. Multiple educational strategies that train clinicians in advanced communication and decision-making offer promising results to optimize antenatal counseling and shared decision-making for families facing possible delivery at extreme prematurity. Continued process evaluation and innovation in these educational domains are needed while also assessing the effect on patient-centered outcomes.
Collapse
Affiliation(s)
- Anne Sullivan
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Center for Bioethics, Harvard Medical School, Boston, MA, USA.
| | - Christy L. Cummings
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA,Center for Bioethics, Harvard Medical School, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA
| |
Collapse
|
10
|
Tucker Edmonds B, Schmidt A, Walker VP. Addressing bias and disparities in periviable counseling and care. Semin Perinatol 2022; 46:151524. [PMID: 34836664 DOI: 10.1016/j.semperi.2021.151524] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Addressing bias and disparities in counseling and care requires that we contend with dehumanizing attitudes, stereotypes, and beliefs that our society and profession holds towards people of color, broadly, and Black birthing people in particular. It also necessitates an accounting of the historically informed, racist ideologies that shape present-day implicit biases. These biases operate in a distinctly complex and damaging manner in the context of end-of-life care, which centers around questions related to human pain, suffering, and value. Therefore, this paper aims to trace biases and disparities that operate in periviable care, where end-of-life decisions are made at the very beginning of life. We start from a historical context to situate racist ideologies into present day stereotypes and tropes that dehumanize and disadvantage Black birthing people and Black neonates in perinatal care. Here, we review the literature, address historical incidents and consider their impact on our ability to deliver patient-centered periviable care.
Collapse
Affiliation(s)
- Brownsyne Tucker Edmonds
- Associate Professor of Obstetrics and Gynecology & Vice Chair for Faculty Development and Diversity, Department of Obstetrics and Gynecology; Assistant Dean for Diversity Affairs, Indiana University School of Medicine, Indianapolis, IN.
| | | | - Valencia P Walker
- Associate Chief Diversity & Health Equity Officer, Nationwide Children's Hospital; Associate Division Chief for Health Equity & Inclusion, Department of Pediatrics, Division of Neonatology, The Ohio State University College of Medicine
| |
Collapse
|
11
|
Disparities in perinatal health: what can we do? J Perinatol 2021; 41:363-364. [PMID: 33510417 DOI: 10.1038/s41372-021-00920-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/08/2022]
|