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Antiel RM, Collura CA, Flake AW, Johnson MP, Rintoul NE, Lantos JD, Curlin FA, Tilburt JC, Brown SD, Feudtner C. Physician views regarding the benefits and burdens of prenatal surgery for myelomeningocele. J Perinatol 2017; 37:994-998. [PMID: 28617430 DOI: 10.1038/jp.2017.75] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 04/07/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Examine how pediatric and obstetrical subspecialists view benefits and burdens of prenatal myelomeningocele (MMC) closure. STUDY DESIGN Mail survey of 1200 neonatologists, pediatric surgeons and maternal-fetal medicine specialists (MFMs). RESULTS Of 1176 eligible physicians, 670 (57%) responded. Most respondents disagreed (68%, 11% strongly) that open fetal surgery places an unacceptable burden on women and their families. Most agreed (65%, 10% strongly) that denying the benefits of open maternal-fetal surgery is unfair to the future child. Most (94%) would recommend prenatal fetoscopic over open or postnatal MMC closure for a hypothetical fetoscopic technique that had similar shunt rates (40%) but decreased maternal morbidity. When the hypothetical shunt rate for fetoscopy was increased to 60%, physicians were split (49% fetoscopy versus 45% open). Views about burdens and fairness correlated with the likelihood of recommending postnatal or fetoscopic over open closure. CONCLUSION Individual and specialty-specific values may influence recommendations about prenatal surgery.
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Affiliation(s)
- R M Antiel
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.,Department of General Surgery, Mayo Clinic, Rochester, MN, USA
| | - C A Collura
- Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.,Division of Neonatal Medicine, Mayo Clinic, Rochester, MN, USA
| | - A W Flake
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - M P Johnson
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - N E Rintoul
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J D Lantos
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, MO, USA
| | - F A Curlin
- Trent Center for Bioethics, Humanities, and History of Medicine, Duke University, Durham, NC, USA
| | - J C Tilburt
- Biomedical Ethics Program, Mayo Clinic, Rochester, MN, USA.,Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - S D Brown
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - C Feudtner
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
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