Neonatologists’ preferences regarding guidelines for periviable deliveries: do we really know what we want?

• Published in: Journal of perinatology Vol. 39; no. 3; pp. 445 - 452
• Main Authors: Krick, Jeanne A., Feltman, Dalia M.
• Format: Journal Article
• Language: English
• Published: New York Nature Publishing Group US 01-03-2019; Nature Publishing Group
• Subjects: 692/308; 692/700/1720; Age; Attitude of Health Personnel; Clinical decision making; Comfort; Cross-Sectional Studies; Decision Making; Emergency response; Female; Gestational Age; Guidelines; Humans; Infant, Extremely Premature; Infant, Newborn; Male; Medicine; Medicine & Public Health; Neonates; Obstetrics; Palliative Care; Parents; Pediatric Surgery; Pediatrics; Practice Guidelines as Topic; Practice Patterns, Physicians; Pregnancy; Resuscitation; Standardization; United States; United States
• ISSN: 0743-8346; 1476-5543
• DOI: 10.1038/s41372-019-0313-1

Objective
To examine neonatology providers’ preferences regarding periviability guidelines.
Study design
An online cross-sectional survey of American Academy of Pediatrics Section on Neonatal-Perinatal Medicine members.
Results
Most of the 480 respondents desired standardized guidelines for upper (85%) and lower (87%) gestational age limits for offering resuscitation and comfort care. Standardization was most to least frequently desired at the national, institutional, and regional levels. Within scenarios involving parents’ preferences conflicting with institutional guidelines, respondents chose parent-preferred options more often (66 vs. 34%). Overall, resuscitation (48%) versus comfort care (52%) were nearly equally chosen. In emergency scenarios, more versus less experienced respondents favored parent-preferred options over guidelines (55 vs. 46%,
p
 = 0.003) and chose resuscitation over comfort care (50 vs. 36%,
p
 < 0.001).
Conclusions
Neonatal providers desire age-based periviability guidelines, but do not agree on the level of standardization. Such limits may be insufficient to guide clinical practice. Policies should include processes that direct providers through fair transparent decision-making.