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Bierer R, Mladucky J, Anderson R, Carey JC. Parent Narratives Provide Perspectives on the Experience of Care in Trisomy 18. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024:e32114. [PMID: 39257320 DOI: 10.1002/ajmg.c.32114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 08/26/2024] [Accepted: 08/29/2024] [Indexed: 09/12/2024]
Abstract
Trisomy 18 syndrome, also known as Edwards syndrome, is the second most common autosomal chromosome syndrome after Down syndrome. Trisomy 18 is a serious medical disorder due to the increased occurrence of structural defects, the high neonatal and infant mortality, and the disabilities observed in older children. Interventions, including cardiac surgery, remain controversial, and the traditional approach is to pursue pure comfort care. While the medical challenges have been well-characterized, there are scant data on the parental views and perspective of the lived experience of rearing a child with trisomy 18. Knowledge of the parental viewpoints can help clinicians guide families through decision-making. Our aim was to identify parents' perspectives by analyzing a series of narratives. In this qualitative study, we collected 46 parent narratives at the 2015 and 2016 conferences of the Support Organization for Trisomy 18 & 13 (SOFT). The participants were asked to "Tell us a story about your experience." Inductive content analysis and close reading were used to identify themes from the stories. Dedoose, a web-based application to analyze qualitative data, was used to code themes more systematically. Of the identified themes, the most common included Impact of trisomy 18 diagnosis and Surpassing expectations. Other themes included Support from professionals, A child, not a diagnosis, and Trust/lack of trust. We examined the voice and the perspectives of the parents in their challenges in caring for their children with this life-limiting condition. The exploration of the themes can ideally guide clinicians in their approach to the counseling and care of the child in a shared decision-making approach.
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Affiliation(s)
- Ryann Bierer
- Divisions of Neonatology and Pediatric Palliative Care, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
| | - Janessa Mladucky
- Department of Maternal Fetal Medicine, Intermountain Health, Murray, Utah, USA
| | - Rebecca Anderson
- Department of Philosophy, University of Utah, Salt Lake City, Utah, USA
| | - John C Carey
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health, Salt Lake City, Utah, USA
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Kim AJH, Marshall M, Gievers L, Tate T, Taub S, Dukhovny S, Ronai C, Madriago EJ. Structured Framework for Multidisciplinary Parent Counseling and Medical Interventions for Fetuses and Infants with Trisomy 13 or Trisomy 18. Am J Perinatol 2024; 41:e2666-e2673. [PMID: 37619598 DOI: 10.1055/s-0043-1772748] [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] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Trisomy 13 (T13) and 18 (T18) are aneuploidies associated with multiple structural congenital anomalies and high rates of fetal demise and neonatal mortality. Historically, patients with either one of these diagnoses have been treated similarly with exclusive comfort care rather than invasive interventions or intensive care, despite a wide phenotypic variation and substantial variations in survival length. However, surgical interventions have been on the rise in this population in recent years without clearly elucidated selection criterion. Our objective was to create a standardized approach to counseling expectant persons and parents of newborns with T13/T18 in order to provide collaborative and consistent counseling and thoughtful approach to interventions such as surgery. STUDY DESIGN This article describes our process and presents our resulting clinical care guideline. RESULTS We formed a multi- and interdisciplinary committee. We used published literature when available and otherwise expert opinion to develop an approach to care featuring individualized assessment of the patient to estimate qualitative mortality risk and potential to benefit from intensive care and/or surgeries centered within an ethical framework. CONCLUSION Through multidisciplinary collaboration, we successfully created a patient-centered approach for counseling families facing a diagnosis of T13/T18. Other institutions may use our approach as a model for developing their own standardized approach. KEY POINTS · Trisomy 13 and trisomy 18 are associated with high but variable morbidity and mortality.. · Research on which patients are most likely to benefit from surgery is lacking.. · We present our institution's framework to counsel families with fetal/neonatal T13/T18..
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Affiliation(s)
- Amanda J H Kim
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Mayme Marshall
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Ladawna Gievers
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Tyler Tate
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Sara Taub
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Stephanie Dukhovny
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
| | - Christina Ronai
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Erin J Madriago
- Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
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Brito S, Williams A, Fox J, Mohammed T, Chahin N, McCarthy K, Nubayaat L, Nunlist S, Brannon M, Xu J, Hendricks-Muñoz KD. Lactation Support as a Proxy Measure of Family-Centered Care Quality in Neonates with Life-Limiting Conditions-A Comparative Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1635. [PMID: 37892298 PMCID: PMC10605637 DOI: 10.3390/children10101635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/17/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Lactation support is an important measure of Family-Centered Care (FCC) in the Neonatal Intensive Care Unit (NICU). Life-limiting conditions (LLCs) raise complex ethical care issues for providers and parents in the NICU and represent a key and often overlooked population for whom FCC is particularly important. We investigated healthcare disparities in FCC lactation support quality in infants with LLCs. METHODS A retrospective cohort of inborn infants with or without LLCs admitted to the NICU between 2015-2023 included 395 infants with 219 LLC infants and 176 matched non-LLC infants and were compared on LLC supports. RESULTS The LLC cohort experienced greater skin-to-skin support, but less lactation specialist visits, breast pumps provided, and human milk oral care use. LLC infants also experienced less maternal visitation, use of donor milk (LLC: 15.5%, non-LLC: 33.5%), and breastfeeds (LLC: 24.2%, non-LLC: 43.2%), with lower mean human milk provision (LLC: 36.6%, non-LLC: 67.1%). LLC infants who survived to discharge had similar human milk use as non-LLC infants (LLC: 49.8%, non-LLC: 50.6%). CONCLUSION Lactation support was significantly absent for families and infants who presented with LLCs in the NICU, suggesting that policies can be altered to increase lactation support FCC quality for this population.
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Affiliation(s)
- Suneeta Brito
- Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Allison Williams
- Department of Psychology, Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Jenny Fox
- Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Tazuddin Mohammed
- Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Nayef Chahin
- Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Kaitlin McCarthy
- Eastern Virginia School of Medicine, P.O. Box 1980, Norfolk, VA 23501-1980, USA
| | | | - Shirley Nunlist
- Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Mason Brannon
- Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Jie Xu
- Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
| | - Karen D Hendricks-Muñoz
- Division of Neonatal Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Virginia Commonwealth University School of Medicine, P.O. Box 980646, Richmond, VA 23298-0646, USA
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Silberberg A, Etchegaray A, Juárez Peñalva S, Villar MJ, Musante G. Attitudes of Argentinean Neonatologists toward Resuscitation of Infants with Trisomies 21, 18, and 13: A Multicenter Survey. Am J Perinatol 2022; 39:1248-1253. [PMID: 33454946 DOI: 10.1055/s-0040-1722602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE This study was aimed to explore the attitude of Argentinean neonatologists in the delivery room on resuscitating infants with trisomies. STUDY DESIGN An anonymous questionnaire was completed by neonatologists staffing level-III neonatal intensive care units (NICUs) on resuscitation of children with trisomies 21, 18, and 13. Potential sociocultural factors influencing the decision to resuscitate were included. RESULTS Overall, 314 neonatologists in 34 units in the Buenos Aires region participated (response rate of 54%). The position of neonatologists regarding the resuscitation in the delivery room was that 98% would resuscitate newborns with trisomy 21, and 47% with trisomy 18 or trisomy 13. Resuscitation of newborns with trisomy 18 or trisomy 13 by neonatologists was significantly associated with working in the public sector, religious beliefs, and legal framework. CONCLUSION With improvement in the management and treatment of infants with trisomies 18 and 13, Argentinean neonatologists showed a favorable attitude toward resuscitating them in the delivery room. KEY POINTS · We explored the attitudes of Argentinean neonatologists on resuscitation of children with trisomies.. · Half of neonatologists would resuscitate newborns with trisomies18 and 13.. · These results suggest an ongoing paradigm shift of the most severe trisomies..
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Affiliation(s)
- Agustín Silberberg
- Department of Bioethics, Hospital Universitario Austral, Universidad Austral, Buenos Aires, Argentina
| | - Adolfo Etchegaray
- Division of Fetal Medicine, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Sofía Juárez Peñalva
- Division of Fetal Medicine, Hospital Universitario Austral, Buenos Aires, Argentina.,Division of Genetics, Hospital Universitario Austral, Universidad Austral, Buenos Aires, Argentina
| | - Marcelo J Villar
- Institute of Translational Research, Facultad de Ciencias Biomédicas, Universidad Austral, Buenos Aires, Argentina
| | - Gabriel Musante
- Division of Neonatology, Hospital Universitario Austral, Universidad Austral, Buenos Aires, Argentina
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Cortezzo DE, Tolusso LK, Swarr DT. Perinatal Outcomes of Fetuses and Infants Diagnosed with Trisomy 13 or Trisomy 18. J Pediatr 2022; 247:116-123.e5. [PMID: 35452657 DOI: 10.1016/j.jpeds.2022.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/31/2022] [Accepted: 04/08/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To identify factors associated with prenatal, perinatal, and postnatal outcomes, and determine medical care use for fetuses and infants with trisomy 13 (T13) and trisomy 18 (T18). STUDY DESIGN This population-based retrospective cohort study included all prenatal and postnatal diagnoses of T13 or T18 in the greater Cincinnati area from January 1, 2012, to December 31, 2018. Overall survival, survival to hospital discharge, medical management, and maternal, fetal, and neonatal characteristics are analyzed. RESULTS There were 124 pregnancies (125 fetuses) that were identified, which resulted in 72 liveborn infants. Male fetal sex and hydrops were associated with a higher rate of spontaneous loss. The median length of survival was 7 and 29 days, for infants with T13 and T18, respectively. Of the 27 infants alive at 1 month of age, 13 (48%) were alive at 1 year of age. Only trisomy type (T13), goals of care (comfort care), and extremely low birthweight were associated with a shorter length of survival. A high degree of variability existed in the use of medical services, with 28% of infants undergoing at least 1 surgical procedure and some children requiring repeated (≤29) or prolonged (>1 year) hospitalizations. CONCLUSIONS Although many infants with T13 or T18 did not survive past the first week of life, nearly 20% lived for more than 1 year with varying degrees of medical support. The length of survival for an infant cannot be easily predicted, and surviving infants have high health care use throughout their lifespans.
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Affiliation(s)
- DonnaMaria E Cortezzo
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Leandra K Tolusso
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Daniel T Swarr
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
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Schuler R, Bedei I, Oehmke F, Zimmer KP, Ehrhardt H. New Challenges with Treatment Advances in Newborn Infants with Genetic Disorders and Severe Congenital Malformations. CHILDREN 2022; 9:children9020236. [PMID: 35204956 PMCID: PMC8870374 DOI: 10.3390/children9020236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/30/2022]
Abstract
Advances in the prognosis of relevant syndromes and severe congenital malformations in infants during the last few decades have enabled the treatment and survival of an ever-increasing number of infants, whose prospects were previously judged futile by professional health care teams. This required detailed counselling for families, which frequently started before birth when a diagnosis was made using genetic testing or ultrasound. Predictions of the estimated prognosis, and frequently the more-or-less broad range of prospects, needed to include the chances of survival and data on acute and long-term morbidities. However, in the interest of a having an informed basis for parental decision-making with a professional interdisciplinary team, this process needs to acknowledge the rights of the parents for a comprehensive presentation of the expected quality of life of their child, the potential consequences for family life, and the couple’s own relationship. Besides expert advice, professional psychological and familial support is needed as a basis for a well-founded decision regarding the best treatment options for the child. It needs to be acknowledged by the professional team that the parental estimate of a “good outcome” or quality of life does not necessarily reflect the attitudes and recommendations of the professional team. Building a mutually trusting relationship is essential to avoid decision conflicts.
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Affiliation(s)
- Rahel Schuler
- Department of General Pediatrics and Neonatology, Justus Liebig University, Feulgenstrasse 12, D-35392 Giessen, Germany; (K.-P.Z.); (H.E.)
- Correspondence:
| | - Ivonne Bedei
- Department of Obstetrics and Gynecology, Justus Liebig University, Klinikstrasse 33, D-35392 Giessen, Germany; (I.B.); (F.O.)
| | - Frank Oehmke
- Department of Obstetrics and Gynecology, Justus Liebig University, Klinikstrasse 33, D-35392 Giessen, Germany; (I.B.); (F.O.)
| | - Klaus-Peter Zimmer
- Department of General Pediatrics and Neonatology, Justus Liebig University, Feulgenstrasse 12, D-35392 Giessen, Germany; (K.-P.Z.); (H.E.)
| | - Harald Ehrhardt
- Department of General Pediatrics and Neonatology, Justus Liebig University, Feulgenstrasse 12, D-35392 Giessen, Germany; (K.-P.Z.); (H.E.)
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Gibelli MABC, de Carvalho WB, Krebs VLJ. Limits of therapeutic intervention in a tertiary neonatal intensive care unit in patients with major congenital anomalies in Brazil. J Paediatr Child Health 2021; 57:1966-1970. [PMID: 34223685 DOI: 10.1111/jpc.15630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/10/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Abstract
AIM Major congenital anomalies are an important cause of death in the neonatal intensive care unit (NICU). Therapeutic interventions and the suspension of those already in place often raise ethical dilemmas in neonatal care. METHODS We analysed treatments-such as ventilatory support, vasoactive drugs, antibiotics, sedation/or analgesia, central venous access and other invasive procedures-offered up to 48 h before death to all newborns with major congenital anomalies over a 3-year period in a NICU in Brazil. We also gathered information contained in medical records concerning conversations with the families and decisions to limit therapeutic interventions. RESULTS We enrolled 74 newborns who were hospitalised from 1 January 2015 to 31 December 2017. A total of 81.1% had central venous access, 74.3% were on ventilatory support, 56.8% received antibiotics and 43.2% used some sedative/analgesic drugs in their final moments. Conversations were registered in medical records in 76% of cases, and 46% of the families chose therapeutic intervention limits. Those who chose to limit therapeutic interventions asked for less exposure to vasoactive drugs (P = 0.003) and antibiotics (P = 0.003), as well as fewer invasive procedures (P = 0.046). There was no change in ventilatory support (P = 0.66), and palliative extubation was not performed for any patient. CONCLUSIONS The therapeutic intervention was mainly characterised by maintenance of the current treatment when a terminal situation was identified with no introduction of new treatments that could increase suffering. The families' approach proved to be essential for making difficult decisions in the NICU.
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Affiliation(s)
- Maria A B C Gibelli
- Child and Adolescent Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Werther B de Carvalho
- Child and Adolescent Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vera L J Krebs
- Child and Adolescent Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Milligan MCP, Jackson LE, Maurer SH. Clinical Course for Patients With Trisomy 13 and 18 Pursuing Life-Prolonging Therapies Versus Comfort-Directed Care. Am J Hosp Palliat Care 2020; 38:1225-1229. [PMID: 33375814 DOI: 10.1177/1049909120985210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Care for infants with Trisomy 13 and 18 is evolving with more children being offered medical and surgical interventions. Parents and clinicians of children diagnosed with trisomy 13 and 18 would benefit from understanding how parental goals of care correlate with the subsequent clinical course of children with these conditions. OBJECTIVE To describe and compare parental goals of care (GOC) and clinical course in infants with trisomy 13 and 18. DESIGN Single center, retrospective (2013-19) analysis of electronic health record repository at a birthing center and a tertiary care hospital. MEASUREMENTS ICD-9/10 codes were used to identify patients with trisomy 13 or 18 born between 2013-2019. Their records were abstracted for their diagnosis, hospitalization days, interventions, GOC, death location and length of life. RESULT Twenty-eight total patients were identified; trisomy 13, mosaic trisomy 13 and trisomy 18 were diagnosed in 9, 2 and 17 patients respectively. Among the 26 patients with complete trisomy 13 or 18, 8 had life-prolonging and 18 had comfort care goals at birth/diagnosis. Life-prolonging goals were not associated with longer life (p = 0.36) but were associated with more mean hospital days (70 vs. 12, p = 0.01), ICU days (66 vs. 9, p = 0.009), intubation (7/8 vs 7/18, p = 0.04), and death in ICU (7/7 vs. 10/17, p = 0.02). Zero patients underwent cardiac surgery. CONCLUSION Parental GOC did not affect length of life in children with complete trisomy, but did alter treatment intensity. This may inform decision making for patients with trisomy 13 or 18.
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Affiliation(s)
- Michelle C Perry Milligan
- Department of Pediatrics, University of Pittsburgh School of Medicine, 6619UPMC Children's Hospital of Pittsburgh, PA, USA.,Department of Pediatrics, Children's Hospital of Philadelphia, PA, USA
| | - Laura E Jackson
- Department of Pediatrics, University of Pittsburgh School of Medicine, PA, USA.,Division of Newborn Medicine, 6619UPMC Children's Hospital of Pittsburgh, PA, USA
| | - Scott H Maurer
- Department of Pediatrics, University of Pittsburgh School of Medicine, 6619UPMC Children's Hospital of Pittsburgh, PA, USA.,Division of Palliative Medicine & Supportive Care, 6619UPMC Children's Hospital of Pittsburgh, PA, USA
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9
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Perinatal Counseling Following a Diagnosis of Trisomy 13 or 18: Incorporating the Facts, Parental Values, and Maintaining Choices. Adv Neonatal Care 2020; 20:204-215. [PMID: 31996562 DOI: 10.1097/anc.0000000000000704] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Families with a prenatal diagnosis of trisomy 13 or 18 are told many things, some true and some myths. They present with differing choices on how to proceed that may or may not be completely informed. PURPOSE To provide the prenatal counselor with a review of the pertinent obstetrical and neonatal outcome data and ethical discussion to help them in supporting families with the correct information for counseling. METHODS/SEARCH STRATEGY This article provides a review of the literature on facts and myths and provides reasonable outcome data to help families in decision making. FINDINGS/RESULTS These disorders comprise a heterogeneous group regarding presentation, outcomes, and parental goals. The authors maintain that there needs to be balanced decision-making between parents and providers for the appropriate care for the woman and her infant. IMPLICATIONS FOR PRACTICE Awareness of this literature can help ensure that prenatal and palliative care consultation incorporates the appropriate facts and parental values and in the end supports differing choices that can support the infant's interests.
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Haghnazarian E, Hu J, Song AY, Friedlich PS, Lakshmanan A. The association of Trisomy 13 and 18 and hospital discharge outcomes among neonates in California: A retrospective cohort study. Pediatr Neonatol 2019; 60:617-622. [PMID: 30935949 PMCID: PMC7062359 DOI: 10.1016/j.pedneo.2019.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/06/2018] [Accepted: 02/26/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Despite Trisomy 13 and 18 being among the most fatal congenital anomalies, limited information exists about resource utilization and factors associated with length of stay (LOS) and total hospital charges (THC) for these anomalies. METHODS We studied data sets of the patient discharge data set from the California Office of Statewide Health Planning and Development from 2006 to 2010, to determine differences in resource utilization for survivors and non-survivors and identify the predictors of LOS and total hospital charges. Descriptive statistics were assessed for demographic and clinical characteristics. General linear regression models were used to identify predictors of LOS and THC. RESULTS Seventy-six Trisomy 13 and 115 Trisomy 18 patients were identified, for whom inpatient mortality was 27.6% and 20.9%, respectively. In patients with Trisomy 13, after adjusting for gender, ethnicity, advanced directive (DNR), insurance and co-morbidities on multivariate analysis, the provision of more than 96 h of mechanical ventilation was associated with significantly increased LOS (standard error, SE) by 18.0 ± 5.3 days and THC (SE) by $399,000 ± $85,000. In terms of insurance type, patients with private coverage had 10.8 ± 4.9 days more than patients with Medicaid. In patients with Trisomy 18, on multivariate analysis, after adjusting for gender, ethnicity, DNR, insurance and co-morbidities, more than 96 h of mechanical ventilation was associated with increased LOS (SE) by 36.8 ± 6.8 days and THC (SE) by $365,000 ± $59,000. CONCLUSION Understanding predictors that are associated with longer LOS and higher THC may be associated in hospital resource allocation for this vulnerable population of infants.
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Affiliation(s)
- Edith Haghnazarian
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States
| | - Jiaqi Hu
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States
| | - Ashley Y Song
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, United States
| | - Philippe S Friedlich
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States
| | - Ashwini Lakshmanan
- Fetal and Neonatal Medicine Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90027, United States; Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, United States; Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, 90089, United States; USC Gehr Family Center for Health Systems Science, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, United States.
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11
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Abdel Razeq NM. Physicians' standpoints on end-of-life decisions at the neonatal intensive care units in Jordan. J Child Health Care 2019; 23:579-595. [PMID: 30606043 DOI: 10.1177/1367493518814926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The purpose of this cross-sectional descriptive study is to explore pediatricians' and neonatologists' attitudes and standpoints on end-of-life (EOL) decision-making in neonates. Seventy-five physicians, employed fulltime to care for newborns in 23 hospitals in Jordan, completed internationally accepted questionnaires. Most physicians (75%) were supportive of using life-sustaining interventions, irrespective of the severity of the newborns' prognosis and the potential burden of the neonates' disabilities on their families. The general attitude of the physicians (59-88%) was against making decisions that limit life support at EOL; even those infants with what are, in fact, untreatable and disabling medical conditions (56-88%). Most physicians (77%) indicated that ethics committees should be involved in EOL decision-making based on requests from parents, physicians, or both. The results of this study indicate strong pro-life attitudes among the physicians whose role is to take care of infants in Jordan. The results also emphasize the need for (1) the creation of clear EOL-focused regulations and guidelines, (2) the establishment of special ethical committees to inform and assist healthcare providers' efforts during EOL care, and (3) raised awareness and competencies regarding EOL and ethical decision-making among physicians taking care of newborns in Jordan's intensive care units.
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Affiliation(s)
- Nadin M Abdel Razeq
- Department of Maternal and Child Health Nursing, School of Nursing, The University of Jordan, Amman, Jordan
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12
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Kukora S, Firn J, Laventhal N, Vercler C, Moore B, Lantos JD. Infant With Trisomy 18 and Hypoplastic Left Heart Syndrome. Pediatrics 2019; 143:peds.2018-3779. [PMID: 30948683 DOI: 10.1542/peds.2018-3779] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 11/24/2022] Open
Abstract
We present a case in which a fetal diagnosis of complex congenital heart disease and trisomy 18 led to a series of decisions for an infant who was critically ill. The parents wanted everything done. The surgeons believed that surgery would be futile. The parents publicized the case on social media, which led to publicity and pressure on the hospital. The case reveals the intersection of parental values, clinical judgments, ethics consultation, insurance company decisions about reimbursement, and social media publicity. Together, these factors complicate the already delicate ethical deliberations and decisions.
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Affiliation(s)
- Stephanie Kukora
- Center for Bioethics and Social Sciences in Medicine, .,Division of Neonatal-Perinatal Medicine, Department of Pediatrics
| | - Janice Firn
- Center for Bioethics and Social Sciences in Medicine.,Division of Professional Education, Department of Learning Health Sciences, and
| | - Naomi Laventhal
- Center for Bioethics and Social Sciences in Medicine.,Division of Neonatal-Perinatal Medicine, Department of Pediatrics
| | - Christian Vercler
- Center for Bioethics and Social Sciences in Medicine.,Department of Surgery, University of Michigan, Ann Arbor, Michigan; and
| | - Bryanna Moore
- Children's Mercy Bioethics Center, Children's Mercy Hospital, Kansas City, Missouri
| | - John D Lantos
- Children's Mercy Bioethics Center, Children's Mercy Hospital, Kansas City, Missouri
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Mullin J, Wolfe J, Bluebond-Langner M, Craig F. Experiences of children with trisomy 18 referred to pediatric palliative care services on two continents. Am J Med Genet A 2019; 179:903-907. [PMID: 30932336 PMCID: PMC6766889 DOI: 10.1002/ajmg.a.61149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/20/2019] [Accepted: 02/27/2019] [Indexed: 11/11/2022]
Abstract
Children with trisomy 18 that survive beyond the neonatal period have multiple congenital anomalies, neurodevelopmental disability, and high mortality rates. The experience of children with trisomy 18 who receive pediatric palliative care services is largely unknown. We conducted a retrospective review of children with trisomy 18 receiving pediatric palliative care services at both Boston Children's Hospital, USA and Great Ormond Street Hospital, UK from January 1, 2004 to January 1, 2015. Fifty-eight children with trisomy 18 were referred to pediatric palliative care, 38 in the United Kingdom, 20 in the United States. Median age at referral was 19 days (2-89) in the United Kingdom, and 25 days (1-463) in the United States. Median length of time being followed by pediatric palliative care was 32 days (1-1,637) in the United Kingdom and 67 days (3-2,442) in the United States. The only significant difference in the two cohorts (p = .001) was in likelihood of receiving cardiac surgical intervention-37% in the United States, 0% the United Kingdom. Children with trisomy 18 receive pediatric palliative care services, with variable age at referral and for a variable length of time. Further research is needed to understand the experience of children with trisomy 18 and their families receiving pediatric palliative care services.
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Affiliation(s)
- Jonathan Mullin
- Department of Pediatrics, Washington University in St Louis, St. Louis, Missouri
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Myra Bluebond-Langner
- Faculty of Population Health Sciences, Louis Dundas Centre for Children's Palliative Care, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Finella Craig
- Louis Dundas Centre for Children's Palliative Care, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
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14
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Kaulfus ME, Gardiner H, Hashmi SS, Mendez-Figueroa H, Miller VJ, Stevens B, Carter R. Attitudes of clinicians toward cardiac surgery and trisomy 18. J Genet Couns 2019; 28:654-663. [PMID: 30688390 DOI: 10.1002/jgc4.1089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 12/05/2018] [Indexed: 11/06/2022]
Abstract
Trisomy 18 is an autosomal trisomy condition characterized by minor to major birth defects, severe disabilities, and high rates of pre- and postnatal mortality. Interventions for these infants have traditionally been withheld with focus instead on palliative support. The issues and attitudes surrounding corrective surgery of congenital heart defects, which is a birth defect that occurs in approximately 90% of infants with trisomy 18, is of our study's interest as recent literature has indicated that cardiac surgery is being performed and may lead to improved survival compared to palliative care. Thus, our study aimed to describe clinician attitudes toward cardiac surgery and trisomy 18. We surveyed 378 clinicians from multiple specialties, including genetic counselors, involved in the pre- and postnatal care of infants with trisomy 18. Descriptive statistics were performed to describe all clinicians' responses, and a secondary analysis with stratifications by clinician type was also performed. Forty-eight percent (n = 378) of clinicians felt it was appropriate to discuss the option of cardiac surgery. Ethical concerns and insufficient outcome data were the most agreed upon reasons for not offering cardiac surgery. Trisomy 18 not being uniformly lethal and expressed parental wishes were the most agreed upon justifications for offering surgery. Clinicians felt the discussion of the option of cardiac surgery is appropriate, however are hesitant due to ethical concerns and insufficient outcome data. Results from this study aim to promote discussion and collaboration among clinicians to improve consistency in patient care.
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Affiliation(s)
- Meagan E Kaulfus
- Clinical Cancer Genetics Program, MD Anderson Cancer Center, University of Texas Genetic Counseling Training Program, The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, Texas
| | - Helena Gardiner
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at Houston, Houston, Texas
| | - S Shahrukh Hashmi
- Department of Pediatrics, McGovern Medical School at Houston, Houston, Texas
| | | | | | - Blair Stevens
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at Houston, Houston, Texas
| | - Rebecca Carter
- Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School at Houston, Houston, Texas
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Winn P, Acharya K, Peterson E, Leuthner S. Prenatal counseling and parental decision-making following a fetal diagnosis of trisomy 13 or 18. J Perinatol 2018; 38:788-796. [PMID: 29740195 DOI: 10.1038/s41372-018-0107-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/06/2018] [Accepted: 03/06/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To evaluate parental decisions following a prenatal diagnosis of trisomy 13 (T13) or trisomy 18 (T18), prenatal counseling received, and pregnancy outcomes. STUDY DESIGN Single-center, retrospective cohort study of families with a prenatal diagnosis of T13 or T18 from 2000 to 2016. RESULTS Out of 152 pregnancies, 55% were terminated. Twenty percent chose induction with palliative care, 20% chose expectant management, 2% chose full interventions, and 3% were lost to follow-up. Counseling was based on initial parental goals, but most women were given options besides termination. Women who chose expectant management had a live birth in 50% of the cases. Women who chose neonatal interventions had a live birth in 100% of the cases, but there were no long-term survivors. CONCLUSIONS The majority of women who continue their pregnancy after a fetal diagnosis of T13 or T18 desire expectant management with palliative care. A live birth can be expected at least half of the time.
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Affiliation(s)
- Phoebe Winn
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Krishna Acharya
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Erika Peterson
- Department of Obstetrics and Gynecology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven Leuthner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
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Arnolds M, Xu L, Hughes P, McCoy J, Meadow W. Worth a Try? Describing the Experiences of Families during the Course of Care in the Neonatal Intensive Care Unit When the Prognosis is Poor. J Pediatr 2018; 196:116-122.e3. [PMID: 29398049 DOI: 10.1016/j.jpeds.2017.12.050] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/28/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To determine how parents of infants in the neonatal intensive care unit with a poor or uncertain prognosis view their experience, and whether they view their choices as "worth it," regardless of outcome. STUDY DESIGN Parents of eligible neonates at 2 institutions underwent audiotaped, semistructured interviews while their infants were still in the hospital and then again 6 months to 1 year after discharge or death. Interviews were transcribed and data were analyzed using thematic analysis. Two authors independently reviewed and coded each interview and discrepancies were resolved by consensus. RESULTS Twenty-six families were interviewed in the initial group and 17 families were interviewed in the follow-up group. The most common themes identified included realism about death (24 families), appreciation for the infant's care team (23 families), and optimism and hope (22 families). Overall themes were very similar across both centers, and among parents of infants who died and those who survived. Themes of regret, futility, distrust of care team, and infant pain were brought up infrequently or not at all. CONCLUSIONS No family believed that the care being provided to their infant was futile; rather, parents were grateful for the care provided to their infant, regardless of outcome. Even in the case of a poor prognosis or the death of an infant, families in our study viewed their infant's stay in the neonatal intensive care unit favorably.
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Affiliation(s)
- Marin Arnolds
- Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, IL; Department of Pediatrics, Evanston Hospital, NorthShore University Healthsystem, Evanston, IL.
| | - Lucy Xu
- University of Chicago Pritzker School of Medicine, Chicago, IL
| | - Patrick Hughes
- Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, IL
| | - Jennifer McCoy
- University of Chicago Pritzker School of Medicine, Chicago, IL; Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - William Meadow
- Department of Pediatrics, University of Chicago Comer Children's Hospital, Chicago, IL; University of Chicago Pritzker School of Medicine, Chicago, IL
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18
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Tsukamoto M, Hitosugi T, Esaki K, Yokoyama T. The Anesthetic Management for a Patient With Trisomy 13. Anesth Prog 2017; 64:162-164. [PMID: 28858551 DOI: 10.2344/anpr-64-02-09] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Trisomy 13 is a chromosomal disorder that occurs in complete or partial mosaic forms. It is characterized by central apnea, mental retardation, seizure and congenital heart disease. The survival of the patients with trisomy 13 is the majority dying before one month. Trisomy 13 is the worst life prognosis among all trisomy syndromes. It is reported the cause of death is central apnea. Special needs patients with mental retardation are recognized to have poorer oral health condition. Oral health related quality of life reflects daily activity and well-being. Dental treatment under general anesthesia is sometimes an option for such patients. This patient had received ventricular septal defect closure surgery at 2-year-old. In addition, he had mental retardation and seizure. Dental treatment had been completed without any cerebral and cardiovascular events under non-invasive monitoring with not only cardiac electric velocimetry, but also epileptogenic activity. In addition, postoperative respiratory condition was maintained stable in room air.
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Affiliation(s)
- Masanori Tsukamoto
- Department of Dental Anesthesiology, Kyushu University Hospital, Fukuoka, Japan
| | - Takashi Hitosugi
- Department of Dental Anesthesiology, Kyushu University Hospital, Fukuoka, Japan
| | - Kanako Esaki
- Department of Dental Anesthesiology, Kyushu University Hospital, Fukuoka, Japan
| | - Takeshi Yokoyama
- Department of Dental Anesthesiology, Kyushu University Hospital, Fukuoka, Japan
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Acharya K, Leuthner S, Clark R, Nghiem-Rao TH, Spitzer A, Lagatta J. Major anomalies and birth-weight influence NICU interventions and mortality in infants with trisomy 13 or 18. J Perinatol 2017; 37:420-426. [PMID: 28079873 PMCID: PMC5738241 DOI: 10.1038/jp.2016.245] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/07/2016] [Accepted: 11/23/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To describe neonatal intensive care unit (NICU) medical interventions and NICU mortality by birth weight and major anomaly types for infants with trisomy 13 (T13) or 18 (T18). STUDY DESIGN Retrospective cohort analysis of infants with T13 or T18 from 2005 to 2012 in the Pediatrix Medical Group. We classified infants into three groups by associated anomaly type: neonatal surgical, non-neonatal surgical and minor. Outcomes were NICU medical interventions and mortality. RESULTS 841 infants were included from 186 NICUs. NICU mortality varied widely by anomaly type and birth weight, from 70% of infants <1500 g with neonatal surgical anomalies to 31% of infants ⩾2500 g with minor anomalies. Infants ⩾1500 g without a neonatal surgical anomaly comprised 66% of infants admitted to the NICU; they had the lowest rates of NICU medical interventions and NICU mortality. CONCLUSIONS Risk stratification by anomaly type and birth weight may help provide more accurate family counseling for infants with T13 and T18.
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Affiliation(s)
- Krishna Acharya
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
| | - Steven Leuthner
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
| | | | | | | | - Joanne Lagatta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee WI
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20
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Hasegawa SL, Fry JT. Moving toward a shared process: The impact of parent experiences on perinatal palliative care. Semin Perinatol 2017; 41:95-100. [PMID: 28238454 DOI: 10.1053/j.semperi.2016.11.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Perinatal palliative care programs seek to support parents expecting a baby diagnosed with a serious medical condition. Clinicians have increasingly recognized the importance of parental perspectives on the medical care mothers and their fetuses and live-born children receive, especially regarding factors influencing individual choices and knowledge of the medical community. We describe, using literature on trisomy 13 and trisomy 18, how information shared between parents and providers can improve perinatal counseling and family support.
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Affiliation(s)
- Susan L Hasegawa
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 45, 225 E. Chicago Ave, Chicago, IL 60611
| | - Jessica T Fry
- Division of Neonatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Box 45, 225 E. Chicago Ave, Chicago, IL 60611.
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21
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Pardo Vargas RA, Aracena M, Aravena T, Cares C, Cortés F, Faundes V, Mellado C, Passalacqua C, Sanz P, Castillo Taucher S. [Congenital anomalies of poor prognosis. Genetics Consensus Committee]. ACTA ACUST UNITED AC 2016; 87:422-431. [PMID: 27234469 DOI: 10.1016/j.rchipe.2016.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The Genetic Branch of the Chilean Society of Paediatrics, given the draft Law governing the decriminalisation of abortion on three grounds, focusing on the second ground, which considers the "embryo or foetus suffering from a congenital structural anomaly or a genetic disorder incompatible with life outside the womb", met to discuss the scientific evidence according to which congenital anomalies (CA) may be included in this draft law. METHODOLOGY Experts in clinical genetics focused on 10 CA, reviewed the literature evidence, and met to discuss it. RESULTS It was agreed not to use the term "incompatible with life outside the womb", as there are exceptions and longer survivals, and change to "congenital anomaly of poor prognosis (CAPP)". Ten CA were evaluated: serious defects of neural tube closure: anencephaly, iniencephaly and craniorachischisis, pulmonary hypoplasia, acardiac foetus, ectopia cordis, non-mosaic triploidy, "limb body wall" complex, "body stalk" anomaly, trisomy 13, trisomy 18, and bilateral renal agenesis. Findings on the prevalence, natural history, prenatal diagnostic methods, survival, and reported cases of prolonged survival were analysed. Post-natal survival, existence of treatments, and outcomes, as well as natural history without intervention, were taken into account in classifying a CA as a CAPP. CONCLUSION A CAPP would be: anencephaly, severe pulmonary hypoplasia, acardiac foetus, cervical ectopia cordis, non-mosaic triploidy, limb body wall complex, body stalk anomaly, non-mosaic trisomy 13, non-mosaic trisomy 18, and bilateral renal agenesis. For their diagnosis, it is required that all pregnant women have access to assessments by foetal anatomy ultrasound and occasionally MRI, and cytogenetic and molecular testing.
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Affiliation(s)
- Rosa A Pardo Vargas
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile.
| | - Mariana Aracena
- Unidad de Genética, Hospital Luis Calvo Mackenna, Santiago, Chile; Unidad de Genética y Enfermedades Metabólicas, División de Pediatría, Pontificia Universidad Católica de Chile, Santiago, Chile; Clínica Santa María, Santiago, Chile
| | - Teresa Aravena
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile; Clínica Indisa, Santiago, Chile
| | - Carolina Cares
- Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile; Clínica Dávila, Santiago, Chile
| | - Fanny Cortés
- Centro de Enfermedades Raras, Clínica Las Condes, Santiago, Chile
| | - Víctor Faundes
- Laboratorio de Genética y Enfermedades Metabólicas, INTA, Universidad de Chile, Santiago, Chile
| | - Cecilia Mellado
- Unidad de Genética, Hospital Sótero del Río, Puente Alto, Chile; Unidad de Genética y Enfermedades Metabólicas, División de Pediatría, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Patricia Sanz
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Sección Genética, Hospital San Juan de Dios, Santiago, Chile
| | - Silvia Castillo Taucher
- Sección Genética, Hospital Clínico Universidad de Chile, Santiago, Chile; Clínica Alemana, Santiago, Chile
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Janvier A, Farlow B, Barrington KJ. Parental hopes, interventions, and survival of neonates with trisomy 13 and trisomy 18. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2016; 172:279-87. [DOI: 10.1002/ajmg.c.31526] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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23
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Donovan JH, Krigbaum G, Bruns DA. Medical interventions and survival by gender of children with trisomy 18. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2016; 172:272-8. [DOI: 10.1002/ajmg.c.31522] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Jacobs AP, Subramaniam A, Tang Y, Philips JB, Biggio JR, Edwards RK, Robin NH. Trisomy 18: A survey of opinions, attitudes, and practices of neonatologists. Am J Med Genet A 2016; 170:2638-43. [DOI: 10.1002/ajmg.a.37807] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/05/2016] [Indexed: 11/05/2022]
Affiliation(s)
| | - Akila Subramaniam
- Division of Maternal-Fetal Medicine; Department of Obstetrics and Gynecology; Birmingham Alabama
- Department of Genetics; University of Alabama at Birmingham; Birmingham Alabama
| | - Ying Tang
- Division of Maternal-Fetal Medicine; Department of Obstetrics and Gynecology; Birmingham Alabama
| | - Joseph B. Philips
- Department of Pediatrics; University of Alabama at Birmingham; Birmingham Alabama
| | - Joseph R. Biggio
- Division of Maternal-Fetal Medicine; Department of Obstetrics and Gynecology; Birmingham Alabama
| | - Rodney K. Edwards
- Division of Maternal-Fetal Medicine; Department of Obstetrics and Gynecology; Birmingham Alabama
| | - Nathaniel H. Robin
- Department of Genetics; University of Alabama at Birmingham; Birmingham Alabama
- Department of Pediatrics; University of Alabama at Birmingham; Birmingham Alabama
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Neonatal Death in the Emergency Department: When End-of-Life Care Is Needed at the Beginning of Life. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
The objective is to examine whether cardiac surgery should be considered for children with trisomy 13 or 18 (T13 or 18).T13 or 18 were previously referred to as "lethal" conditions due to high mortality rates and severe disability among survivors. In the last decade, investigations have revealed these conditions are heterogeneous, with increasing numbers of studies describing interventions for these children. A number of factors makes the interpretation of reported outcomes after cardiac surgery challenging: (1) dissimilarities in practice lead to a wide variation in reported outcomes after cardiac surgery; (2) cardiac surgery is generally offered to older, healthier children; (3) cardiac surgeries of widely varying risks are often lumped together in individual studies, and (4) cases where cardiac surgery has been withheld are generally not included in publications. It is unclear whether withholding cardiac surgery for some children with a ventricular septal defect will lead to death, or the development of pulmonary hypertension, or if death will occur from other causes. In this article, we describe two children with different clinical situations and examine whether cardiac surgery would benefit them and how to communicate with their families. Cardiac surgery may be beneficial to some children with trisomy 13 or 18, but may harm others. Every child should be approached in an individual fashion and the goals of each family should be addressed. Children who are more likely to benefit from surgery may be older, healthier children without respiratory support. Rigorous and transparent research is needed to identify factors that affect survival in trisomy 13 or 18.
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Affiliation(s)
- Annie Janvier
- Department of Pediatrics, University of Montreal, Montreal, Canada; Unité d'éthique clinique, Hôpital Sainte-Justine, Quebec, Canada; Research Center, Hôpital Sainte-Justine, Quebec, Canada.
| | - Barbara Farlow
- The DeVeber Institute for Bioethics and Social Research, Ontario, Canada; Patients for Patient Safety, Ontario, Canada
| | - Keith Barrington
- Department of Pediatrics, University of Montreal, Montreal, Canada; Research Center, Hôpital Sainte-Justine, Quebec, Canada
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Management Considerations for Ongoing Pregnancies Complicated by Trisomy 13 and 18. Obstet Gynecol Surv 2016; 71:295-300. [DOI: 10.1097/ogx.0000000000000304] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Bruns DA, Martinez A. An analysis of cardiac defects and surgical interventions in 84 cases with full trisomy 18. Am J Med Genet A 2015; 170A:337-343. [DOI: 10.1002/ajmg.a.37427] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 09/23/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Deborah A. Bruns
- Department of Counseling; Quantitative Methods, and Special Education; Southern Illinois University Carbondale; Carbondale Illinois
| | - Alyssa Martinez
- Department of Counseling; Quantitative Methods, and Special Education; Southern Illinois University Carbondale; Carbondale Illinois
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29
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Marugán de Miguelsanz J, Torres Hinojal M, Rodriguez Fernández L. Conflictos éticos en el establecimiento de niveles asistenciales en la trisomía 18. An Pediatr (Barc) 2014; 81:406-7. [DOI: 10.1016/j.anpedi.2014.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 01/09/2014] [Indexed: 11/25/2022] Open
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30
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Bruns DA, Campbell E. Nine children over the age of one year with full trisomy 13: A case series describing medical conditions. Am J Med Genet A 2014; 164A:2987-95. [DOI: 10.1002/ajmg.a.36689] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/30/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Deborah A. Bruns
- Department of Educational Psychology and Special Education; Southern Illinois University Carbondale; Mailcode 4618 Carbondale Illinois 62901
| | - Emily Campbell
- Department of Educational Psychology and Special Education; Southern Illinois University Carbondale; Mailcode 4618 Carbondale Illinois 62901
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