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Chen YJ, Yu WH, Chen LW, Huang CC, Kang L, Lin HS, Iwata O, Kato S, Hussein MH, Lin YC. Improved Survival of Periviable Infants after Alteration of the Threshold of Viability by the Neonatal Resuscitation Program 2015. CHILDREN-BASEL 2021; 8:children8010023. [PMID: 33406755 PMCID: PMC7824697 DOI: 10.3390/children8010023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 01/11/2023]
Abstract
Periviable infants (PIs) born at 22–25 weeks gestational age (wGA) have a variable survival rate (49.7–86.2%) among hospitals. One factor involved in this difference may be the definition of the threshold of viability. The American Academy of Pediatrics revised the neonatal resuscitation program in late 2015 (NRP 2015) and altered the threshold of viability from 23 to 22 wGA. The impact on the survival of PIs after the guideline alteration has seldom been discussed. Since 2016, the unit of this study has implemented the renewed guideline for PIs. We retrospectively reviewed and analyzed the survival and clinical variables of PIs before and after implementation of the guideline, which included a 10-year cohort in a single center in Taiwan. There were 168 PIs enrolled between 2010 and 2019 (Epoch-I, 2010–2015; Epoch-II, 2016–2019), after excluding those with congenital anomalies and parent-decided comfort care. Compared to those in Epoch-I, the PIs in Epoch-II had significantly higher odds ratios (2.602) (95% confidence interval: 1.170–5.789; p = 0.019) for survival. Younger gestational age, small size for gestational age, cesarean delivery, low blood pH at birth, and surfactant therapeutic treatment were found to be significant risk factors associated with the survival of PIs (p < 0.05 for each). The altered threshold of viability by NRP 2015 may impact the survival of PIs. However, long-term follow-up for surviving PI is required in the future.
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Affiliation(s)
- Yen-Ju Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
| | - Wen-Hao Yu
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
| | - Li-Wen Chen
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
| | - Chao-Ching Huang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
| | - Lin Kang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan;
| | - Hui-Shan Lin
- Department of Nursing, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan;
| | - Osuke Iwata
- Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Science, Nagoya, Aichi 467-8601, Japan; (O.I.); (S.K.)
| | - Shin Kato
- Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Science, Nagoya, Aichi 467-8601, Japan; (O.I.); (S.K.)
| | - Mohamed Hamed Hussein
- Department of Neonatology, Center of Maternal, Fetal and Neonatal Medicine, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama 350-8550, Japan
- Correspondence: (M.H.H.); (Y.-C.L.); Tel.: +81-492-283-727 (M.H.H.); +886-62353535-3236 (Y.-C.L.)
| | - Yung-Chieh Lin
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng-Kung University, Tainan 70457, Taiwan; (Y.-J.C.); (W.-H.Y.); (L.-W.C.); (C.-C.H.)
- Correspondence: (M.H.H.); (Y.-C.L.); Tel.: +81-492-283-727 (M.H.H.); +886-62353535-3236 (Y.-C.L.)
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Kavanaugh K, Savage T, Kilpatrick S, Kimura R, Hershberger P. Life support decisions for extremely premature infants: report of a pilot study. J Pediatr Nurs 2005; 20:347-59. [PMID: 16182094 DOI: 10.1016/j.pedn.2005.03.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this pilot study was to describe decision making and the decision support needs of parents, physicians, and nurses regarding life support decisions made over time prenatally and postnatally for extremely premature infants. Using the collective case study method, one prenatal, one postnatal, and one postdeath, if the infant had died, tape-recorded interviews were conducted with each parent. With parents' permission, prenatal interviews were done with the physicians and nurses who talked to them about life support decisions for their infants. Twenty-five tape-recorded interviews were conducted with six cases (six mothers, two fathers, six physicians, and two nurses). Hospital records were reviewed for documentation of life support decisions. Results of this pilot study demonstrated that most parents wanted a model of shared decision making and perceived that they were informed and involved in making decisions. Parents felt that to be involved in decision making they needed information and recommendations from physicians. Parents also stressed the importance of encouragement and hope. In contrast, physicians informed parents but most physicians felt that parents were the decision makers. Physicians used parameters to offer options or involve parents in decisions and became very directive at certain gestational ages. Nurses reported that they believed that parents needed information from the physician first, then they would reinforce information. The results of this study offer an initial understanding of the decision support needs of parents.
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Affiliation(s)
- Karen Kavanaugh
- University of Illinois at Chicago College of Nursing, 60612, USA.
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