Antenatal counselling at the cusp of viability and parental decision-making in the zone of parental discretion: A cohort study.

IF 1.6 4区 医学 Q2 PEDIATRICS
Jessica Sabljak, Tammy Brinsmead
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引用次数: 0

Abstract

Aim: Safer Care Victoria updated a clinical guideline on extreme prematurity in 2020, reducing the threshold for offering resuscitation from 23 to 22 weeks gestation. The zone of parental discretion is the interval of shared decision-making between parents and doctors regarding resuscitation decisions. It is especially relevant at this periviable gestation. Our study aimed to establish current practices in antenatal counselling and steroid administration at this cusp of viability, and examine the decisions made during the zone of parental discretion.

Methods: Single centre retrospective cohort study. Sixteen thousand three hundred fifty-four admissions and emergency department presentations between January 2021 and July 2023 were retrieved from Birthing Outcomes System (BOS) and patient details were imported and manually reviewed on Microsoft Excel, with particular note to the gestation at admission/emergency department presentation and duration of admission. Eighty-seven patients were identified as present in the hospital between 21 + 0 and 22 + 6 weeks gestation. These 87 scanned records on Clinical Patient Folder (CPF) were then manually reviewed to identify if antenatal counselling occurred during this window. Thirty-six patients were included who received antenatal counselling between 21 + 0 and 22 + 6 weeks gestation (the remaining patients did not receive antenatal counselling during this window), and relevant data was subsequently extracted from the scanned medical record and analysed using SPSS software (IBM SPSS Statistics 29).

Results: Thirty-six women received antenatal counselling between 21 + 0 and 22 + 6 weeks. 58% decided on full resuscitation and 39% opted for comfort care if their infant was to be born between 22 + 0 and 22 + 6 weeks. All but one baby born premature were exposed to steroids, with 83.3% receiving a full course. Twenty-eight infants (62.2%) were fully steroid loaded at the time of delivery. In those fully steroid loaded, 31.1% of the time steroids were initiated prior to transfer, 50% of the time deferred until neonatal review and a decision regarding the resuscitation status of the baby, and on one occasion requested by the neonatologist before counselling.

Conclusion: Patients at risk for premature birth who attended our hospital at the cusp of viability were generally counselled about the opportunity for resuscitation between 22 + 0 and 22 + 6 weeks gestational age, and offered steroids. Further studies are required to establish whether the content of antenatal counselling, and the timing of steroids, are consistent in this population.

存活边缘的产前咨询与父母自由决定区的父母决策:一项队列研究。
目的:2020 年,维多利亚州加强护理署更新了关于极度早产儿的临床指南,将提供复苏的阈值从孕 23 周降至 22 周。父母自由裁量权区是父母和医生就复苏决定共同做出决策的区间。这一点在围孕期尤为重要。我们的研究旨在确定在这一存活期的产前咨询和类固醇用药方面的现行做法,并检查在父母自由裁量区内做出的决定:方法:单中心回顾性队列研究。从 "分娩结果系统"(BOS)中检索了 2021 年 1 月至 2023 年 7 月期间的 16354 例入院和在急诊科就诊的患者,并在 Microsoft Excel 中导入和人工审核了患者的详细信息,特别是入院/在急诊科就诊时的妊娠期和入院时间。有 87 名患者被确认为妊娠 21+0 周至 22+6 周之间入院。然后对这 87 份临床病人文件夹(CPF)上的扫描记录进行人工审核,以确定是否在此时间段内进行了产前咨询。其中有 36 名患者在妊娠 21+0 至 22+6 周期间接受了产前咨询(其余患者未在此时间段接受产前咨询),随后从扫描的医疗记录中提取了相关数据,并使用 SPSS 软件(IBM SPSS Statistics 29)进行了分析:36 名产妇在 21+0 周至 22+6 周期间接受了产前咨询。如果婴儿在 22+0 到 22+6 周之间出生,58% 的产妇决定进行全面复苏,39% 的产妇选择舒适护理。除一名婴儿外,所有早产儿都接受了类固醇治疗,其中 83.3% 的婴儿接受了全疗程治疗。28 名婴儿(62.2%)在分娩时完全使用了类固醇。在这些完全使用类固醇的婴儿中,31.1%的婴儿在转院前就开始使用类固醇,50%的婴儿在转院后推迟使用类固醇,直到新生儿科医生对婴儿的复苏状况进行复查并做出决定后才开始使用类固醇,还有一次是新生儿科医生在咨询前要求婴儿使用类固醇:结论:在我院就诊的高危早产儿一般都在胎龄 22+0 到 22+6 周之间接受了有关复苏机会的咨询,并获得了类固醇治疗。还需要进一步研究,以确定产前咨询的内容和类固醇的使用时间在这一人群中是否一致。
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来源期刊
CiteScore
2.90
自引率
5.90%
发文量
487
审稿时长
3-6 weeks
期刊介绍: The Journal of Paediatrics and Child Health publishes original research articles of scientific excellence in paediatrics and child health. Research Articles, Case Reports and Letters to the Editor are published, together with invited Reviews, Annotations, Editorial Comments and manuscripts of educational interest.
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