Antenatal Counseling Regarding Resuscitation at an Extremely Low Gestational Age
- 1 July 2009
- journal article
- Published by American Academy of Pediatrics (AAP) in PEDIATRICS
- Vol. 124 (1), 422-427
- https://doi.org/10.1542/peds.2009-1060
Abstract
The anticipated delivery of an extremely low gestational age infant raises difficult questions for all involved, including whether to initiate resuscitation after delivery. Each institution caring for women at risk of delivering extremely preterm infants should provide comprehensive and consistent guidelines for antenatal counseling. Parents should be provided the most accurate prognosis possible on the basis of all the factors known to affect outcome for a particular case. Although it is not feasible to have specific criteria for when the initiation of resuscitation should or should not be offered, the following general guidelines are suggested. If the physicians involved believe there is no chance for survival, resuscitation is not indicated and should not be initiated. When a good outcome is considered very unlikely, the parents should be given the choice of whether resuscitation should be initiated, and clinicians should respect their preference. Finally, if a good outcome is considered reasonably likely, clinicians should initiate resuscitation and, together with the parents, continually reevaluate whether intensive care should be continued. Whenever resuscitation is considered an option, a qualified individual, preferably a neonatologist, should be involved and should be present in the delivery room to manage this complex situation. Comfort care should be provided for all infants for whom resuscitation is not initiated or is not successful.Keywords
This publication has 44 references indexed in Scilit:
- Intensive Care for Extreme Prematurity — Moving beyond Gestational AgeThe New England Journal of Medicine, 2008
- Understanding neurodevelopment in premature infants: Applied chaos theoryThe Journal of Pediatrics, 2006
- Early prediction of poor outcome in extremely low birth weight infants by classification tree analysisThe Journal of Pediatrics, 2006
- The Ethics of Neonatal Resuscitation at the Margins of Viability: Informed Consent and OutcomesThe Journal of Pediatrics, 2005
- Outcome of extreme prematurity: as information increases so do the dilemmasArchives of Disease in Childhood: Fetal & Neonatal, 2005
- Changes in Neurodevelopmental Outcomes at 18 to 22 Months' Corrected Age Among Infants of Less Than 25 Weeks' Gestational Age Born in 1993–1999Pediatrics, 2005
- Delivery room decision-making at the threshold of viabilityThe Journal of Pediatrics, 2004
- ACOG PRACTICE BULLETIN NO 38, SEPTEMBER 2002. PERINATAL CARE AT THE THRESHOLD OF VIABILITYInternational Journal of Gynecology & Obstetrics, 2002
- School-Age Consequences of Birth Weight Less Than 750 g: A Review and UpdateDevelopmental Neuropsychology, 2000
- Gestational age in pregnancies after in vitro fertilization: comparison between ultrasound measurements and actual ageUltrasound in Obstetrics & Gynecology, 1998