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Randriamboarison D, Fustec E, Enderlé I, Yverneau M, Le Breton K, Lassel L, Mazille-Orfanos N, Pladys P. Qualitative analysis of mothers' perception related to the delivery of information regarding preterm births. BMC Pregnancy Childbirth 2024; 24:272. [PMID: 38609842 PMCID: PMC11015681 DOI: 10.1186/s12884-024-06404-3] [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: 03/05/2023] [Accepted: 03/11/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Preterm birth is a major health issue due to its potential outcomes and socioeconomic impact. Prenatal counseling is of major importance for parents because it is believed that the risk of preterm birth is associated with a higher parental mental burden. Nowadays in France, the content and delivery of antenatal counseling is based on personal experience since there is a lack of official guidelines. The goal of the study was to evaluate maternal perception of antenatal information delivered in the setting of preterm births. METHODS A qualitative study was performed using semi-structured individual interviews of 15 mothers with a child born > 26-34 GW. Data analysis was based on a constant comparative method. RESULTS Concerning prenatal counseling content, parents wanted to be informed of their role in the care of their preterm child more so than statistics that were not always considered relevant. Parents' reactions to the announcement of the risk of a preterm birth was dominated by stupefaction, uncertainty and anxiety. When it comes to the setting of prenatal counseling, patients' room was deemed an appropriate setting by parents and ideally the presence of a coparent was appreciated as it increased patients' understanding. The physicians' attitude during the counseling was considered appropriate and described as empathic and optimistic. The importance of support throughout the hospitalization in the form of other parents' experiences, healthcare professionals and the possibility to preemptively visit the NICU was emphasized by participants. Delivery experience was dominated by a sense of uncertainty, and urgency. Some leads for improvement included additional support of information such as virtual NICU visit; participants also insisted on continuity of care and the multidisciplinary aspect of counseling (obstetrician, neonatologist, midwife, nurse, lactation consultant and psychologist). CONCLUSION Highlighting parents' expectations about prenatal counseling could lead to the establishment of overall general guidelines. However, some topics like the use of statistics and mentioning the risk of death underline the importance of a personalized information.
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Affiliation(s)
| | - Elisa Fustec
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, 35000, France
| | - Isabelle Enderlé
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, 35000, France
- Faculty of Medicine Rennes 1 University, Rennes, France
| | - Mathilde Yverneau
- Department of Neonatology, University Hospital of Rennes, Rennes, 35000, France
- Faculty of Medicine Rennes 1 University, Rennes, France
| | - Karine Le Breton
- Department of Neonatology, University Hospital of Rennes, Rennes, 35000, France
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, 35000, France
| | - Linda Lassel
- Department of Obstetrics and Gynecology, University Hospital of Rennes, Rennes, 35000, France
| | | | - Patrick Pladys
- Department of Neonatology, University Hospital of Rennes, Rennes, 35000, France
- Faculty of Medicine Rennes 1 University, Rennes, France
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Geurtzen R, Wilkinson DJC. Incorporating parental values in complex paediatric and perinatal decisions. THE LANCET. CHILD & ADOLESCENT HEALTH 2024; 8:225-235. [PMID: 38219752 DOI: 10.1016/s2352-4642(23)00267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 01/16/2024]
Abstract
Incorporating parental values in complex medical decisions for young children is important but challenging. In this Review, we explore what it means to incorporate parental values in complex paediatric and perinatal decisions. We provide a narrative overview of the paediatric, ethics, and medical decision-making literature, focusing on value-based and ethically complex decisions for children who are too young to express their own preferences. We explain key concepts and definitions, discuss paediatric-specific features, reflect on challenges in learning and expressing values for both parents and health-care providers, and provide recommendations for clinical practice. Decisional values are informed by global and external values and could relate to the child, the parents, and the whole family. These values should inform preferences and assure value-congruent choices. Additionally, parents might hold various meta values on the process of decision making itself. Complex decisions for young children are emotionally taxing, ethically difficult, and often surrounded by uncertainty. These contextual factors make it more likely that values and preferences are initially absent or unstable and need to be constructed or stabilised. Health-care professionals and parents should work together to construct and clarify values and incorporate them into personalised decisions for the child. An open communication style, with unbiased and tailored information in a supportive environment, is helpful. Dedicated training in communication and shared decision making could help to improve the incorporation of parental values in complex decisions for young children.
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Affiliation(s)
- Rosa Geurtzen
- Amalia Children's Hospital, Radboud Institute of Healthcare Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
| | - Dominic J C Wilkinson
- Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, UK; Oxford Newborn Care Unit, John Radcliffe Hospital, Oxford University, Oxford, UK; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore
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3
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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.
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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
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Schneider K, Müller J, Schleußner E. German obstetrician's self-reported attitudes and handling in threatening preterm birth at the limits of viability. J Perinat Med 2023; 51:1097-1103. [PMID: 37256371 DOI: 10.1515/jpm-2022-0547] [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: 11/12/2022] [Accepted: 05/04/2023] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Antenatal treatment and information influences the course of pregnancy and parental decision-making in cases of threatened prematurity on the borderline of viability. Numerous studies have shown significant interprofessional differences in assessing ethical boundary decisions; hence, this study aimed to evaluate obstetricians attitudes, practices and antenatal parental counseling regarding threatened preterm birth in Germany. METHODS An anonymous online questionnaire was administered to 543 obstetricians at tertiary perinatal centers and prenatal diagnostic centers in Germany. The survey contained questions on basic ethical issues assessed using the Likert scale and a case vignette regarding the practical procedures of an imminent extreme premature birth at 23 1/7 gestational weeks. RESULTS In the case of unstoppable preterm birth, 15 % of clinicians said they would carry out a cesarean section; however, specialists from centers with a high number of very low birth weight infants would do so significantly more often. Among respondents, 29.8 % did not take any therapeutic measures without discussing the child's treatment options with their parents, 19.9 % refused to offer actionable advice to the parents, and 57 % said they would advise parents to seek intensive care treatment for the child with the option of changing treatment destination in the event of serious complications. Moreover, 84 % said they would provide information together with neonatologists. CONCLUSIONS Joint counseling with neonatologists is widely accepted. The size of the perinatal center significantly influences the practical approach to threatened preterm births. Respect for parents' decision-making autonomy regarding the child's treatment options is central and influences therapy initiation.
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Affiliation(s)
- Katja Schneider
- Department of Neonatology, Charité University Medicine Berlin, Berlin, Germany
| | - Johanna Müller
- Department of Obstetrics, University Hospital Jena, Jena, Germany
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Mielewczyk FJ, Boyle EM. Uncharted territory: a narrative review of parental involvement in decision-making about late preterm and early term delivery. BMC Pregnancy Childbirth 2023; 23:526. [PMID: 37464284 DOI: 10.1186/s12884-023-05845-6] [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: 01/18/2023] [Accepted: 07/11/2023] [Indexed: 07/20/2023] Open
Abstract
Almost 30% of live births in England and Wales occur late preterm or early term (LPET) and are associated with increased risks of adverse health outcomes throughout the lifespan. However, very little is known about the decision-making processes concerning planned LPET births or the involvement of parents in these. This aim of this paper is to review the evidence on parental involvement in obstetric decision-making in general, to consider what can be extrapolated to decisions about LPET delivery, and to suggest directions for further research.A comprehensive, narrative review of relevant literature was conducted using Medline, MIDIRS, PsycInfo and CINAHL databases. Appropriate search terms were combined with Boolean operators to ensure the following broad areas were included: obstetric decision-making, parental involvement, late preterm and early term birth, and mode of delivery.This review suggests that parents' preferences with respect to their inclusion in decision-making vary. Most mothers prefer sharing decision-making with their clinicians and up to half are dissatisfied with the extent of their involvement. Clinicians' opinions on the limits of parental involvement, especially where the safety of mother or baby is potentially compromised, are highly influential in the obstetric decision-making process. Other important factors include contextual factors (such as the nature of the issue under discussion and the presence or absence of relevant medical indications for a requested intervention), demographic and other individual characteristics (such as ethnicity and parity), the quality of communication; and the information provided to parents.This review highlights the overarching need to explore how decisions about potential LPET delivery may be reached in order to maximise the satisfaction of mothers and fathers with their involvement in the decision-making process whilst simultaneously enabling clinicians both to minimise the number of LPET births and to optimise the wellbeing of women and babies.
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Affiliation(s)
- Frances J Mielewczyk
- Leicester City Football Club (LCFC) Research Programme, Department of Population Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK.
| | - Elaine M Boyle
- Department of Population Health Sciences, College of Life Sciences, George Davies Centre, University of Leicester, University Road, Leicester, LE1 7RH, UK
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Haward MF, Lorenz JM, Janvier A, Fischhoff B. Antenatal consultation and deliberation: adapting to parental preferences. J Perinatol 2023; 43:895-902. [PMID: 36725985 DOI: 10.1038/s41372-023-01605-8] [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: 09/25/2022] [Revised: 12/28/2022] [Accepted: 01/10/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyze and compare perspectives on antenatal consultation and decision-making from participants with varying degrees of prematurity experience and clinician-experts. STUDY DESIGN Open-ended interviews structured around topics previously identified by recognized clinician-experts were conducted with participants having different levels of prematurity experience. Analysis used mixed methods (thematic and mental models analysis). Secondary sub-group comparisons were performed, based on degree of experience. RESULTS Non-clinician participants' (n = 80) perspectives differed regarding: amount and content of information desired, decision-making strategies, and who - parent or clinician - should direct consultations. Most wanted to retain decisional authority, all recognized their emotional limitations and many advocated for deliberation support. Participants worried parents' would regret choosing palliative care contrary to clinicians. Bereaved parents often saw issues differently. CONCLUSIONS Parents approach risk and decision-making for extremely premature infants in a personal fashion. They need personalized support tailored to their unique circumstances, decision-making preferences, and emotions.
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Affiliation(s)
- Marlyse F Haward
- Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - John M Lorenz
- Department of Pediatrics, Morgan Stanley Children Hospital of New York and Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Annie Janvier
- Department of Pediatrics, Bureau de l'Éthique Clinique, Université de Montréal and Division of Neonatology, Research Center, Clinical Ethics Unit, Palliative Care Unit, Unité de recherche en éthique clinique et partenariat famille, CHU Sainte-Justine, Montréal, QC, Canada
| | - Baruch Fischhoff
- Institute for Politics and Strategy, and Department of Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
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Bartlett MJ, Umoren R, Amory JH, Huynh T, Kim AJH, Stiffler AK, Mastroianni R, Ficco E, French H, Gray M. Measuring antenatal counseling skill with a milestone-based assessment tool: a validation study. BMC MEDICAL EDUCATION 2023; 23:325. [PMID: 37165398 PMCID: PMC10170031 DOI: 10.1186/s12909-023-04282-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Antenatal counseling for parents in the setting of expected preterm delivery is an important component of pediatric training. However, healthcare professionals receive a variable amount and quality of formal training. This study evaluated and discussed validity of a practical tool to assess antenatal counseling skills and provide evaluative feedback: the Antenatal Counseling Milestones Scale (ACoMS). METHODS Experts in antenatal counseling developed an anchored milestone-based tool to evaluate observable skills. Study participants with a range of antenatal counseling skills were recruited to participate in simulation of counseling sessions in person or via video with standardized patient actors presenting with preterm labor at 23 weeks' gestation. Two faculty observers scored each session independently using the ACoMS. Participants completed an ACoMS self-assessment, demographic, and feedback survey. Validity was measured with weighted kappas for inter-rater agreement, Kruskal-Wallis and Dunn's tests for milestone levels between degrees of expertise in counseling, and cronbach's alpha for item consistency. RESULTS Forty-two participants completed observed counseling sessions. Of the 17 items included in the tool, 15 items were statistically significant with scores scaling with level of training. A majority of elements had fair-moderate agreement between raters, and there was high internal consistency amongst all items. CONCLUSION This study demonstrates that the internal structure of the ACoMS rubric has greater than fair inter-rater reliability and high internal consistency amongst items. Content validity is supported by the scale's ability to discern level of training. Application of the ACoMS to clinical encounters is needed to determine utility in clinical practice.
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Affiliation(s)
| | - Rachel Umoren
- University of Washington School of Medicine, Seattle, 98105, USA
| | | | - Trang Huynh
- Oregon Health & Science University, Portland, USA
| | | | | | | | - Ellie Ficco
- University of Washington School of Medicine, Seattle, 98105, USA
| | | | - Megan Gray
- University of Washington School of Medicine, Seattle, 98105, USA
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8
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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.
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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
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9
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An e-Delphi study on mode of delivery and extremely preterm breech singletons. J Perinatol 2023; 43:15-22. [PMID: 35864218 DOI: 10.1038/s41372-022-01458-7] [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] [Received: 01/21/2022] [Revised: 06/30/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To understand clinicians' consensus on mode of delivery in extremely preterm breech infants; assess knowledge on neonatal outcomes and its impact on consensus. STUDY DESIGN A two-round Delphi of obstetrical or neonatal care providers, recruited from national conferences and investigator networks. Round one assessed decision-making (vignettes), and knowledge; the second round reassessed vignettes after presenting outcome data. RESULTS In round one (102 respondents), consensus (a priori, ≥75% agreement) was achieved in 4/13 vignettes: two when likely/very likely to offer Cesarean (26 and 27 weeks) and two for unlikely/very unlikely (23 weeks growth restriction, ± adverse features). Clinicians generally underestimated neonatal outcomes. In round two (87 respondents), three scenarios achieved consensus (likely/very likely to offer Cesarean at 25-27 weeks); in five other vignettes, not offering Cesarean was reduced in ≥15% of respondents. CONCLUSION Limited consensus exists on extremely preterm breech mode of delivery, partly associated with neonatal outcome underestimation. GESTATIONAL AGE NOTATION The authors follow the World Health Organization's notation on gestational age. Under this notation, the first day of the last menstrual period (LMP) is day 0 of week 0. Therefore, days 0-6 represent completed week 0, days 7-13 represent completed week 1 and so on.
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10
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Bode LM, Jager SM, Panoch J, Hoffman SM, Laitano T, Kavanaugh K, Tucker Edmonds B. Mode of delivery in the context of periviable birth: informed deference and shared decision-making. J Perinatol 2023; 43:23-28. [PMID: 36402860 DOI: 10.1038/s41372-022-01537-9] [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] [Received: 02/28/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To qualitatively evaluate women's perspectives on shared decision-making for periviable (22-25 weeks' gestational age) mode of delivery (MOD). STUDY DESIGN Interviews were conducted at two Midwestern academic hospitals with 30 women hospitalized for threatened periviable delivery between September 2016 and January 2018. Prior to delivery (T1) and at 3-months postpartum (T2), MOD-related decision-making was explored using prompts. Interviews were coded and analyzed using NVivo 12. RESULT The majority of women perceived the MOD options as cesarean section or vaginal delivery. Most ultimately preferred "whatever's best for baby." Understanding of MOD risks was limited, and physicians recommended each option equally. Sixteen participants perceived themselves as decision-makers at T1, while at T2, only nine participants identified themselves as such. CONCLUSION Informed deference is introduced as a novel concept in the setting of periviable MOD decision-making, whereby the mother defers decisional authority to the provider, the baby, a higher power, or the circumstance itself.
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Affiliation(s)
- Leah M Bode
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shannon M Jager
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Janet Panoch
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Shelley M Hoffman
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Tatiana Laitano
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Karen Kavanaugh
- Children's Hospital of Wisconsin, Milwaukee, WI, USA.,College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Brownsyne Tucker Edmonds
- Department of Obstetrics & Gynecology, Indiana University School of Medicine, Indianapolis, IN, USA.
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11
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Schoeber NHC, Linders M, Binkhorst M, De Boode WP, Draaisma JMT, Morsink M, Nusmeier A, Pas M, van Riessen C, Turner NM, Verhage R, Fluit CRMG, Hogeveen M. Healthcare professionals' knowledge of the systematic ABCDE approach: a cross-sectional study. BMC Emerg Med 2022; 22:202. [PMID: 36510149 PMCID: PMC9743501 DOI: 10.1186/s12873-022-00753-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 11/18/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The Airway, Breathing, Circulation, Disability and Exposure (ABCDE) approach is a universal, priority-based approach for the assessment and treatment of critically ill patients. Although the ABCDE approach is widely recommended, adherence in practice appears to be suboptimal. The cause of this non-compliance is unknown. As knowledge is a prerequisite for adherence, the aim of this study was to assess healthcare professionals' knowledge of the ABCDE approach. METHODS A cross-sectional study was conducted at the Radboud University Medical Center, the Netherlands. A digital multiple-choice assessment tool of the ABCDE approach was developed by an expert panel through a mini-Delphi method and validated by performing test item statistics and an expert-novice comparison. The validated test was sent to healthcare professionals (nurses, residents and medical specialists) of the participating departments: Anaesthesiology, Paediatrics, Emergency Department and the Neonatal, Paediatric and Adult Intensive Care Units. Primary outcome was the test score, reflecting individual level of knowledge. Descriptive statistics, regression analysis and ANOVA were used. RESULTS Test validation showed a Cronbach's alpha of 0.71 and an expert-novice comparison of 91.9% (standard deviation (SD) 9.1) and 72.4% (15.2) respectively (p < 0.001). Of 954 eligible participants, 240 filled out the questionnaire. The mean (SD) test score (% of correct answers) was 80.1% (12.2). Nurses had significantly lower scores (74.9% (10.9)) than residents (92.3% (7.5)) and medical specialists (88.0% (8.6)) (p < 0.001). The Neonatal Intensive Care Unit (75.9% (12.6)) and Adult Intensive Care Unit (77.4% (11.2)) had significantly lower scores than Paediatric Intensive Care Unit (85.6% (10.6)), Emergency Department (85.5% (10.4)) and Anaesthesiology (85.3% (10.6)) (p < 0.05). Younger participants scored higher than older participants (-0.30% (-0.46;-0.15) in test score/year increase in age). CONCLUSION Scores of a validated knowledge test regarding the ABCDE approach vary among healthcare professionals caring for critically ill patients. Type of department, profession category and age had a significant influence on the test score. Further research should relate theoretical knowledge level to clinical practice. Tailored interventions to increase ABCDE-related knowledge are recommended.
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Affiliation(s)
- Nino H. C. Schoeber
- grid.461578.9Department of Neonatology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Marjolein Linders
- grid.461578.9Department of Neonatology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Mathijs Binkhorst
- grid.461578.9Department of Neonatology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Willem-Pieter De Boode
- grid.461578.9Department of Neonatology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Jos M. T. Draaisma
- grid.10417.330000 0004 0444 9382Department of Paediatrics, Radboud University Medical Center Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Marlies Morsink
- grid.10417.330000 0004 0444 9382Department of Emergency Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Anneliese Nusmeier
- grid.10417.330000 0004 0444 9382Paediatric Intensive Care Unit, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Martijn Pas
- grid.461578.9Department of Neonatology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
| | - Christine van Riessen
- grid.10417.330000 0004 0444 9382Department of Anaesthesia and Pain, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nigel M. Turner
- grid.7692.a0000000090126352Division of Vital Functions, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Rutger Verhage
- grid.10417.330000 0004 0444 9382Intensive Care Unit, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Cornelia R. M. G. Fluit
- grid.10417.330000 0004 0444 9382Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marije Hogeveen
- grid.461578.9Department of Neonatology, Radboud University Medical Center, Amalia Children’s Hospital, Nijmegen, the Netherlands
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Krick JA, Feltman DM, Arnolds M. Decision-Making for Extremely Preterm Infants: A Qualitative Systematic Review. J Pediatr 2022; 251:6-16. [PMID: 35940293 DOI: 10.1016/j.jpeds.2022.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To synthesize and describe important elements of decision-making during antenatal consultation for threatened preterm delivery at the margin of gestational viability. STUDY DESIGN Data sources including PubMed, EMBASE, Web of Science, and CINAHL Plus were searched. We included all qualitative literature published on decision-making from 1990 to July 2021. Two authors independently screened and evaluated each study using the Critical Appraisal Skills Programme checklist; studies reaching moderate and high quality were included. We developed an extraction tool to collect and categorize data from each qualitative article, then used thematic analysis to analyze and describe the findings. RESULTS Twenty-five articles incorporating the views of 504 providers and 352 parents were included for final review. Thematic analysis revealed 4 main themes describing the experience of health care providers and parents participating in decision-making: factors that influence decision-making, information sharing, building a partnership, and making the decision. Parents and providers were not always in agreement upon which elements were most essential to the process of decision-making. Articles published in languages other than English were excluded. CONCLUSIONS Qualitative literature highlighting key factors which are important during antenatal counseling can inform and guide providers through the process of shared decision-making. Communicating clear, honest, and balanced information; avoiding artificially dichotomized options; and focusing on partnership building with families will help providers use the antenatal consultation to reach personalized decisions for each infant.
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Affiliation(s)
- Jeanne A Krick
- Department of Pediatrics, Brooke Army Medical Center, San Antonio, TX.
| | - Dalia M Feltman
- Division of Neonatology, Department of Pediatrics, Evanston Hospital, NorthShore University Health System, Evanston, IL; Pritzker School of Medicine, University of Chicago, Chicago, IL
| | - Marin Arnolds
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI
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De Proost L, Bunnik E, de Boer A, Verweij EJJ. Postponed Withholding: Harmful for the Infant and Increasing the Complexity of Decision-Making. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:56-59. [PMID: 36332056 DOI: 10.1080/15265161.2022.2123978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
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14
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De Proost L, Geurtzen R, Ismaili M'hamdi H, Reiss IKMI, Steegers EAPE, Joanne Verweij EJ. Prenatal counseling for extreme prematurity at the limit of viability: A scoping review. PATIENT EDUCATION AND COUNSELING 2022; 105:1743-1760. [PMID: 34872804 DOI: 10.1016/j.pec.2021.10.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To explore, based on the existing body of literature, main characteristics of prenatal counseling for parents at risk for extreme preterm birth. METHODS A scoping review was conducted searching Embase, Medline, Web of Science, Cochrane, CINAHL, and Google Scholar. RESULTS 46 articles were included. 27 of them were published between 2017 and 2021. More than half of them were conducted in the United States of America. Many different study designs were represented. The following characteristics were identified: personalization, parent-physician relationships, shared decision-making, physician bias, emotions, anxiety, psychosocial factors, parental values, religion, spirituality, hope, quality of life, and uncertainty. CONCLUSIONS Parental values are mentioned in 37 of the included articles. Besides this, uncertainty, shared decision-making, and emotions are most frequently mentioned in the literature. However, reflecting on the interrelation between all characteristics leads us to conclude that personalization is the most notable trend in prenatal counseling practices. More and more, it is valued to adjust the counseling to the parent(s). PRACTICE IMPLICATIONS This scoping review emphasizes again the complexity of prenatal counseling at the limit of viability. It offers an exploration of how it is currently approached, and reflects on how future research can contribute to optimizing it.
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Affiliation(s)
- Lien De Proost
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, Rotterdam, The Netherlands; Department of Neonatology, Erasmus MC, Rotterdam, The Netherlands; Department of Obstetrics & Gynecology, Erasmus MC, Rotterdam The Netherlands.
| | - Rosa Geurtzen
- Department of Neonatology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Hafez Ismaili M'hamdi
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, Rotterdam, The Netherlands
| | | | - E A P Eric Steegers
- Department of Obstetrics & Gynecology, Erasmus MC, Rotterdam The Netherlands
| | - E J Joanne Verweij
- Department of Obstetrics & Gynecology, Erasmus MC, Rotterdam The Netherlands; Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
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15
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Do neonatologists in Spain offer an interview with parents during pregnancy? National survey. An Pediatr (Barc) 2022; 96:367-369. [DOI: 10.1016/j.anpede.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/05/2021] [Indexed: 11/30/2022] Open
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17
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Respectful Maternity Care Framework and Evidence-Based Clinical Practice Guideline. J Obstet Gynecol Neonatal Nurs 2022; 51:e3-e54. [PMID: 35101344 DOI: 10.1016/j.jogn.2022.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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18
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Verweij EJ, De Proost L, Hogeveen M, Reiss IKM, Verhagen AAE, Geurtzen R. Dutch guidelines on care for extremely premature infants: Navigating between personalisation and standardization. Semin Perinatol 2022; 46:151532. [PMID: 34839939 DOI: 10.1016/j.semperi.2021.151532] [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: 10/19/2022]
Abstract
OBJECTIVE There is no international consensus on what type of guideline is preferred for care at the limit of viability. We aimed to conceptualize what type of guideline is preferred by Dutch healthcare professionals: 1) none; 2) gestational-age-based; 3) gestational-age-based-plus; or 4) prognosis-based via a survey instrument. Additional questions were asked to explore the grey zone and attitudes towards treatment variation. FINDING 769 surveys were received. Most of the respondents (72.8%) preferred a gestational-age-based-plus guideline. Around 50% preferred 24+0/7 weeks gestational age as the lower limit of the grey zone, whereas 26+0/7 weeks was the most preferred upper limit. Professionals considered treatment variation acceptable when it is based upon parental values, but unacceptable when it is based upon the hospital's policy or the physician's opinion. CONCLUSION In contrast to the current Dutch guideline, our results suggest that there is a preference to take into account individual factors besides gestational age.
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Affiliation(s)
- E J Verweij
- Department of Obstetrics, LUMC, Albinusdreef 2, Leiden ZA 2333, the Netherlands; Department of Obstetrics and Gynaecology, Erasmus MC, the Netherlands.
| | - Lien De Proost
- Department of Obstetrics and Gynaecology, Erasmus MC, the Netherlands; Department of Neonatology, Erasmus MC, the Netherlands; Department of Medical Ethics, Philosophy and History of Medicine, Erasmus MC, the Netherlands
| | - Marije Hogeveen
- Department of Neonatology, Radboud University Medical Centre, Amalia Children's Hospital, the Netherlands
| | - I K M Reiss
- Department of Neonatology, Erasmus MC, the Netherlands
| | - A A E Verhagen
- Department of Paediatrics, University Medical Centre Groningen, University of Groningen, the Netherlands
| | - Rosa Geurtzen
- Department of Neonatology, Radboud University Medical Centre, Amalia Children's Hospital, the Netherlands
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19
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Controversies in treatment practices of the mother-infant dyad at the limit of viability. Semin Perinatol 2022; 46:151539. [PMID: 34887106 DOI: 10.1016/j.semperi.2021.151539] [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: 11/20/2022]
Abstract
In the setting of threatened extreme preterm birth, balancing maternal and fetal risks and benefits in order to choose the best available treatment options is of utmost importance. Inconsistency in treatment practices for infants born between 22 and 24 weeks of gestatotional age may account for inter-hospital variation in survival rates with and without impairment. Most importantly, non-biased and accurate information must be presented to the family as soon as extremely preterm birth is suspected, including counseling on morbidities and mortality associated with delivery at the limits of viability. This review will focus on different therapeutic medical and surgical practices available for threatened extremely preterm birth to improve fetal and maternal outcomes while highlighting the importance of patient-centered approaches.
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20
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van den Heuvel JFM, Hogeveen M, Lutke Holzik M, van Heijst AFJ, Bekker MN, Geurtzen R. Digital decision aid for prenatal counseling in imminent extreme premature labor: development and pilot testing. BMC Med Inform Decis Mak 2022; 22:7. [PMID: 34991580 PMCID: PMC8734286 DOI: 10.1186/s12911-021-01735-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 12/14/2021] [Indexed: 01/04/2023] Open
Abstract
Background In case of extreme premature delivery at 24 weeks of gestation, both early intensive care and palliative comfort care for the neonate are considered treatment options. Prenatal counseling, preferably using shared decision making, is needed to agree on the treatment option in case labor progresses. This article described the development of a digital decision aid (DA) to support pregnant women, partners and clinicians in prenatal counseling for imminent extreme premature labor.
Methods This DA is developed following the International Patient Decision Aid Standards. The Dutch treatment guideline and the Dutch recommendations for prenatal counseling in extreme prematurity were used as basis. Development of the first prototype was done by expert clinicians and patients, further improvements were done after alpha testing with involved clinicians, patients and other experts (n = 12), and beta testing with non-involved clinicians and patients (n = 15). Results The final version includes information, probabilities and figures depending on users’ preferences. Furthermore, it elicits patient values and provides guidance to aid parents and professionals in making a decision for either early intensive care or palliative comfort care in threatening extreme premature delivery. Conclusion A decision aid was developed to support prenatal counseling regarding the decision on early intensive care versus palliative comfort care in case of extreme premature delivery at 24 weeks gestation. It was well accepted by parents and healthcare professionals. Our multimedia, digital DA is openly available online to support prenatal counseling and personalized, shared decision-making in imminent extreme premature labor. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01735-z.
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Affiliation(s)
- Josephus F M van den Heuvel
- Department of Obstetrics, Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marije Hogeveen
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Internal Code 804, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Margo Lutke Holzik
- Department of Obstetrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Arno F J van Heijst
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Internal Code 804, PO Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics, Wilhelmina's Children Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rosa Geurtzen
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Internal Code 804, PO Box 9101, 6500HB, Nijmegen, The Netherlands.
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21
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Simma B, den Boer M, Nakstad B, Küster H, Herrick HM, Rüdiger M, Aichner H, Kaufmann M. Video recording in the delivery room: current status, implications and implementation. Pediatr Res 2021:10.1038/s41390-021-01865-0. [PMID: 34819653 DOI: 10.1038/s41390-021-01865-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 11/07/2021] [Accepted: 11/08/2021] [Indexed: 11/09/2022]
Abstract
Many factors determine the performance and success of delivery room management of newborn babies. Improving the quality of care in this challenging surrounding has an important impact on patient safety and on perinatal morbidity and mortality. Video recording (VR) offers the advantage to record and store work as done rather than work as recalled. It provides information about adherence to algorithms and guidelines, and technical, cognitive and behavioural skills. VR is feasible for education and training, improves team performance and results of research led to changes of international guidelines. However, studies thus far have not provided data regarding whether delivery room video recording affects long-term team performance or clinical outcomes. Privacy is a concern because data can be stored and individuals can be identified. We describe the current state of clinical practice in high- and low-resource settings, discuss ethical and medical-legal issues and give recommendations for implementation with the aim of improving the quality of care and outcome of vulnerable babies. IMPACT: VR improves performance by health caregivers providing neonatal resuscitation, teaching and research related to delivery room management, both in high as well low resource settings. VR enables information about adherence to guidelines, technical, behavioural and communication skills within the resuscitation team. VR has ethical and medical-legal implications for healthcare, especially recommendations for implementation of VR in routine clinical care in the delivery room. VR will increase the awareness that short- and long-term outcomes of babies depend on the quality of care in the delivery room.
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Affiliation(s)
- B Simma
- Department of Paediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria.
| | - M den Boer
- Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
| | - B Nakstad
- Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
- Division of Paediatrics and Adolescent Medicine, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - H Küster
- Clinic for Paediatric Cardiology, Intensive Care and Neonatology, University Medical Centre Göttingen, Göttingen, Germany
| | - H M Herrick
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M Rüdiger
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Saxony Center for Feto-Neonatal Health, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - H Aichner
- Department of Paediatrics, Academic Teaching Hospital, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - M Kaufmann
- Division of Neonatology and Paediatric Intensive Care Medicine, Department of Paediatrics, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
- Saxony Center for Feto-Neonatal Health, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
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22
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What information do parents facing extremely preterm birth really need? Ethik Med 2021. [DOI: 10.1007/s00481-021-00656-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Kim AJ, Umoren R, Gray MM. Teaching Antenatal Counseling Skills via Video Conference. Cureus 2021; 13:e17030. [PMID: 34522511 PMCID: PMC8425487 DOI: 10.7759/cureus.17030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/08/2021] [Indexed: 11/21/2022] Open
Abstract
Neonatologists provide counseling to expectant parents to prepare them for the birth and subsequent medical care that their extremely preterm, or otherwise medically complex newborn may require. The skills required to conduct these sensitive conversations are often taught to neonatology trainees via direct observation or simulated scenarios in advance of counseling actual patients. This technical report details how we taught antenatal counseling skills to junior neonatal-perinatal medicine (NPM) fellows via video conferencing during the coronavirus disease 2019 (COVID-19) pandemic. This approach could be used to effectively prepare future trainees to perform antenatal counseling.
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Affiliation(s)
- Amanda J Kim
- Pediatrics/Neonatal-Perinatal Medicine, Oregon Health and Science University, Portland, USA
| | - Rachel Umoren
- Neonatology, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, USA
| | - Megan M Gray
- Neonatology, Seattle Children's Hospital/University of Washington School of Medicine, Seattle, USA
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24
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Geurtzen R, van den Heuvel JFM, Huisman JJ, Lutke Holzik EM, Bekker MN, Hogeveen M. Decision-making in imminent extreme premature births: perceived shared decision-making, parental decisional conflict and decision regret. J Perinatol 2021; 41:2201-2207. [PMID: 34285357 DOI: 10.1038/s41372-021-01159-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 07/09/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To describe levels of perceived shared decision making (SDM), decisional conflict (DC), and decision regret (DR) in prenatal counseling by pregnant women, partners, neonatologists, and obstetricians regarding decision-making around imminent extreme premature birth in which a decision about palliative comfort care versus early intensive care had to be made. STUDY DESIGN Multicenter, cross-sectional study using surveys to determine perceived SDM at imminent extreme premature birth in parents and physicians, and to determine DC and DR in parents. RESULTS In total, 73 participants from 22 prenatal counseling sessions were included (21 pregnant women, 20 partners, 14 obstetricians, 18 neonatologists). High perceived levels of SDM were found (median 82,2), and low levels of DC (median 23,4) and DR at one month (median 12, 5). CONCLUSIONS Reported levels of self-perceived SDM in the setting of prenatal counseling in extreme prematurity were high, by both the parents and the physicians. Levels of DC and DR were low.
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Affiliation(s)
- R Geurtzen
- Amalia Children's Hospital, department of neonatology, Radboud university medical center, Nijmegen, The Netherlands.
| | - J F M van den Heuvel
- Department of Obstetrics and Gynecology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - J J Huisman
- Department of Obstetrics and Gynecology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - E M Lutke Holzik
- Department of Obstetrics and Gynecology, Leiden University Medical Center, Leiden, The Netherlands
| | - M N Bekker
- Department of Obstetrics and Gynecology, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - M Hogeveen
- Amalia Children's Hospital, department of neonatology, Radboud university medical center, Nijmegen, The Netherlands
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25
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López González MF, Vela Enríquez F, García Martín R, Vargas Pérez M. [Do neonatologists in Spain offer an interview with parents during pregnancy? National survey]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00238-1. [PMID: 34344637 DOI: 10.1016/j.anpedi.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/23/2021] [Accepted: 07/05/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
| | | | - Raúl García Martín
- Unidad de Apoyo a la Investigación, Hospital de Poniente, El Ejido, Almería, España
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26
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Fish R, Weber A, Crowley M, March M, Thompson C, Voos K. Early antenatal counseling in the outpatient setting for high-risk pregnancies: a randomized control trial. J Perinatol 2021; 41:1595-1604. [PMID: 33510421 PMCID: PMC10718404 DOI: 10.1038/s41372-021-00933-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/07/2020] [Accepted: 01/15/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Determine if antenatal counseling delivered in the outpatient setting improves parental knowledge and satisfaction without contributing to anxiety. STUDY DESIGN Randomized control trial at a large academic institution. Mothers at risk for preterm delivery were enrolled following routine maternal-fetal medicine (MFM) visits and randomized to early antenatal counseling of prematurity or standard counseling by MFM providers. The primary outcome was parental knowledge of prematurity. Secondary outcomes included parental satisfaction, anxiety scores, and compliance with recommended follow-up. RESULTS Seventy-six women were enrolled, 38 in each group. Early counseling group had higher knowledge scores (86.3 vs 64.3, p = <0.001) and parental satisfaction (p = 0.003). Anxiety scores were similar between the two groups (38.2 vs 40.4, p = 0.53). No difference was noted in compliance with follow-up. CONCLUSIONS Antenatal counseling in the high-risk outpatient setting improved parental knowledge and satisfaction without leading to increased anxiety.
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Affiliation(s)
- Rebecca Fish
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA.
| | | | - Moira Crowley
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Melissa March
- University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Kristin Voos
- Rainbow Babies and Children's Hospital, Cleveland, OH, USA
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27
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van Beek PE, Groenendaal F, Broeders L, Dijk PH, Dijkman KP, van den Dungen FAM, van Heijst AFJ, van Hillegersberg JL, Kornelisse RF, Onland W, Schuerman FABA, van Westering-Kroon E, Witlox RSGM, Andriessen P. Survival and causes of death in extremely preterm infants in the Netherlands. Arch Dis Child Fetal Neonatal Ed 2021; 106:251-257. [PMID: 33158971 PMCID: PMC8070636 DOI: 10.1136/archdischild-2020-318978] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 08/27/2020] [Accepted: 09/21/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE In the Netherlands, the threshold for offering active treatment for spontaneous birth was lowered from 25+0 to 24+0 weeks' gestation in 2010. This study aimed to evaluate the impact of guideline implementation on survival and causes and timing of death in the years following implementation. DESIGN National cohort study, using data from the Netherlands Perinatal Registry. PATIENTS The study population included all 3312 stillborn and live born infants with a gestational age (GA) between 240/7 and 266/7 weeks born between January 2011 and December 2017. Infants with the same GA born between January 2007 and December 2009 (N=1400) were used as the reference group. MAIN OUTCOME MEASURES Survival to discharge, as well as cause and timing of death. RESULTS After guideline implementation, there was a significant increase in neonatal intensive care unit (NICU) admission rate for live born infants born at 24 weeks' GA (27%-69%, p<0.001), resulting in increased survival to discharge in 24-week live born infants (13%-34%, p<0.001). Top three causes of in-hospital mortality were necrotising enterocolitis (28%), respiratory distress syndrome (19%) and intraventricular haemorrhage (17%). A significant decrease in cause of death either complicated or caused by respiratory insufficiency was seen over time (34% in 2011-2014 to 23% in 2015-2017, p=0.006). CONCLUSIONS Implementation of the 2010 guideline resulted as expected in increased NICU admissions rate and postnatal survival of infants born at 24 weeks' GA. In the years after implementation, a shift in cause of death was seen from respiratory insufficiency towards necrotising enterocolitis and sepsis.
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Affiliation(s)
- Pauline E van Beek
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisa Broeders
- The Netherlands Perinatal Registry, Utrecht, The Netherlands
| | - Peter H Dijk
- Department of Neonatology, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, The Netherlands
| | - Koen P Dijkman
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
| | | | - Arno F J van Heijst
- Department of Neonatology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - René F Kornelisse
- Department of Pediatrics, Devision of Neonatology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Wes Onland
- Department of Neonatology, Emma Childrens Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | - Ruben S G M Witlox
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Peter Andriessen
- Department of Neonatology, Máxima Medical Centre, Veldhoven, The Netherlands
- Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
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28
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Carlson R, Battin MR, Bennet L, Gunn AJ. Fifty-three years of follow-up of an infant with neonatal encephalopathy treated with therapeutic hypothermia. Pediatr Res 2021; 89:1117-1118. [PMID: 33173172 DOI: 10.1038/s41390-020-01256-x] [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: 09/08/2020] [Revised: 09/25/2020] [Accepted: 10/11/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Robert Carlson
- Psychology Department, Dixie State University, 225 South 700, East St. George, UT, USA
| | | | - Laura Bennet
- Department of Physiology, The University of Auckland, Auckland, New Zealand
| | - Alistair J Gunn
- Department of Physiology, The University of Auckland, Auckland, New Zealand.
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Georgescu A, Muthusamy A, Basir MA. The 30-Minute Sprint: Recognizing Intrapartum Prematurity Counseling Limitations. J Pediatr Intensive Care 2021; 11:282-286. [DOI: 10.1055/s-0041-1724096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022] Open
Abstract
AbstractDescribe the characteristics and content of intrapartum counseling provided to women hospitalized for premature birth between 23 and 34 weeks' gestation age (GA). The study was conducted between April and December 2009 in two teaching hospitals with labor and delivery units and level 3 neonatal intensive care units. Counselors completed a postcounseling survey. From 60 sessions, 46 surveys were collected. The median counseling duration was 30 minutes; this was not associated with gestational age. The support-person was not present for most (57%) counseling sessions. There was a positive correlation (p = 0.001) between the number of maternal questions and her education. There was no difference in counseling content across the 23 to 34 weeks' GA regarding delivery room care, physical/mental disability, and vision problems. This study of characteristics and content of premature birth counseling for birth between 23 and 34 weeks' GA found that the duration of most sessions is 30 minutes; the father of the baby is not present during counseling for most premature births, and the topics discussed by counselors are fairly similar and extensive irrespective of the GA. These findings highlight the existing contrast between the recommended counseling practices and the actual practice reported by counselors.
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Affiliation(s)
- Abigail Georgescu
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Anbu Muthusamy
- Department of Pediatrics, Baylor Scott & White Medical Center, Temple, Texas, United Sates
| | - Mir A. Basir
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
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De Proost L, Verweij EJT, Ismaili M'hamdi H, Reiss IKM, Steegers EAP, Geurtzen R, Verhagen AAE. The Edge of Perinatal Viability: Understanding the Dutch Position. Front Pediatr 2021; 9:634290. [PMID: 33598441 PMCID: PMC7882530 DOI: 10.3389/fped.2021.634290] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 01/08/2021] [Indexed: 11/17/2022] Open
Abstract
The current Dutch guideline on care at the edge of perinatal viability advises to consider initiation of active care to infants born from 24 weeks of gestational age on. This, only after extensive counseling of and shared decision-making with the parents of the yet unborn infant. Compared to most other European guidelines on this matter, the Dutch guideline may be thought to stand out for its relatively high age threshold of initiating active care, its gray zone spanning weeks 24 and 25 in which active management is determined by parental discretion, and a slight reluctance to provide active care in case of extreme prematurity. In this article, we explore the Dutch position more thoroughly. First, we briefly look at the previous and current Dutch guidelines. Second, we position them within the Dutch socio-cultural context. We focus on the Dutch prioritization of individual freedom, the abortion law and the perinatal threshold of viability, and a culturally embedded aversion of suffering. Lastly, we explore two possible adaptations of the Dutch guideline; i.e., to only lower the age threshold to consider the initiation of active care, or to change the type of guideline.
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Affiliation(s)
- L. De Proost
- Department of Medical Ethics, Philosophy and History of Medicine, Rotterdam, Netherlands
- Department of Neonatology, Rotterdam, Netherlands
- Department of Obstetrics and Gynecology, Rotterdam, Netherlands
| | - E. J. T. Verweij
- Department of Obstetrics and Gynecology, Rotterdam, Netherlands
- Department of Obstetrics, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - H. Ismaili M'hamdi
- Department of Medical Ethics, Philosophy and History of Medicine, Rotterdam, Netherlands
| | | | | | - R. Geurtzen
- Department of Neonatology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, Netherlands
| | - A. A. E. Verhagen
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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On the limits of viability: toward an individualized prognosis-based approach. J Perinatol 2020; 40:1736-1738. [PMID: 32826936 DOI: 10.1038/s41372-020-00793-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/24/2020] [Accepted: 08/10/2020] [Indexed: 11/08/2022]
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Rau NM, Basir MA, Flynn KE. Parental understanding of crucial medical jargon used in prenatal prematurity counseling. BMC Med Inform Decis Mak 2020; 20:169. [PMID: 32698793 PMCID: PMC7376726 DOI: 10.1186/s12911-020-01188-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 07/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parent-clinician shared decision making is the recommended model for the care of premature infants; thus, clinicians provide prenatal prematurity counseling to parents in the event of a mother's hospitalization for premature birth. However, parental understanding of medical jargon commonly used during prematurity counseling is unknown. METHODS Within an overall research agenda to develop and test an educational aid for prenatal prematurity education, we designed the Parental Knowledge of Premature Birth questionnaire. To evaluate parental comprehension of the medical jargon contained within the questionnaire, we conducted cognitive interviews, a formal method for evaluating comprehension and response to questionnaire items. Parents were recruited from a Level IV Neonatal Intensive Care Unit; purposeful recruitment ensured diversity with respect to gender, race, literacy level, and child's gestational age. Data collection and analysis followed standard qualitative methods for cognitive interviewing. We report on the insights gained from these cognitive interviews regarding parental understanding of crucial medical jargon commonly used during prenatal prematurity counseling. RESULTS Participants included 10 women and 6 men who ranged in age from 23 to 38 years and represented Black/African-American (38%), Asian (6%), and white (56%) backgrounds. Five participants (31%) had less than a high school education or reading level below 9th grade (Wide Range Achievement Test version 4 reading subtest). In the first round of interviews, parents of all education and literacy levels had difficulty with medical jargon commonly used in prematurity counseling. Terms that parents found difficult to understand included "gestational age", "mild or no developmental problems", and "neonatologist". Modified terms tested in a second round of interviews showed improved comprehension. CONCLUSION Cognitive interviews provided empirical testing of parental understanding of crucial medical jargon and highlighted that language commonly used during prenatal prematurity counseling is not understood by many parents. For parents to participate in shared decision making, plain language should be used to maximize their understanding of medical information.
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Affiliation(s)
- Nicole M Rau
- Department of Pediatrics, Medical College of Wisconsin, 999 N 92nd St, Suite C410, PO Box 1997, Wauwatosa, WI, 53226, USA
| | - Mir A Basir
- Department of Pediatrics, Medical College of Wisconsin, 999 N 92nd St, Suite C410, PO Box 1997, Wauwatosa, WI, 53226, USA
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave. Suite C5500, Milwaukee, WI, 53226, USA.
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A clinical rule for the difficulty prediction on scalp intravenous access in infants (SIAI) from emergency room. Sci Rep 2020; 10:6624. [PMID: 32313154 PMCID: PMC7170871 DOI: 10.1038/s41598-020-63771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 03/31/2020] [Indexed: 11/09/2022] Open
Abstract
Infant intravenous access poses a significant challenge to the operator. Scalp vein is the ideal location for emergency medical staff to perform intravenous access for administration of fluids or medications. To tackle this challenge, we developed a clinical rule for the difficulty prediction on scalp intravenous access in infants (SIAI) conducting a prospective cohort study in a pediatric emergency room. A total of 658 infant patients who underwent SVI from January 2017 to September 2018 were recruited in this study. The failure rate of SIAI on the first attempt was 20.2%. Five variables, including dehydration condition, obesity, vein invisibility, vein impalpability and hyperactive status of infant, were independently and statistically associated with failure rate of SIAI. Furthermore, we indicated that any one alone of the above five variables did not significantly lead to greater than 50% failure rate of indwelling needle SIAI (p > 0.05). However, summary effects of more than one of these five variables were statistically significant associated with greater than 50% failure rate of SIAI (p < 0.05). When employing the five-variable model, validation cohort subjects displayed dehydration, obesity, vein invisibility, vein impalpability and hyperactive status had a 67.5% likelihood of failed first attempt on SIAI (C = 0.675; 95% CI: 0.622–0.727; p < 0.001). For the first time, we developed the difficult model for SIAI. We found that dehydration, obesity, vein invisibility, vein impalpability and hyperactive status of the infant patients are the independent and significant predictors associated with SIAI failure. Our predicted model indicates that infant patients with combination of more than one of the five variables contribute to greater than 50% failure rate of indwelling needle in SIAI.
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