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PLoS One. 2019 Aug 29;14(8):e0221859. doi: 10.1371/journal.pone.0221859. eCollection 2019.

Prenatal parental involvement in decision for delivery room management at 22-26 weeks of gestation in France - The EPIPAGE-2 Cohort Study.

Author information

1
CHU Lille Neonatal unit, EA Epidemiology and Quality of Care, Lille, France.
2
Department of Neonatology, Centre Hospitalier Intercommunal de Creteil, Créteil, France.
3
CEDITEC, University Paris Est Creteil, France.
4
Department of biostatistics, Univ. Lille, CHU Lille, Lille, France.
5
Inserm UMR, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France.
6
Maternité Olympe de Gouges, Centre Hospitalier Regional Universitaire Tours, France.
7
Department of Neonatology, Assistance Publique-Hôpitaux de Marseille, Nord Hospital, Marseille, France.
8
Aix-Marseille University, CNRS, EFS, ADES, Marseille, France.
9
Maternity Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France.
10
Department of Neonatology, Hospices Civils de Lyon, Hôpital Femme Mère Enfants.
11
Claude Bernard University, EAM, France.
12
Pôle Femme-Enfant, CHU, Rennes, France.
13
Sorbonne Université Paris, France, Service de Néonatologie, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Paris, France.

Abstract

OBJECTIVE:

Our main objective was to examine if parental prenatal preferences predict delivery-room management of extremely preterm periviable infants. The secondary objectives were to describe parental involvement and the content of prenatal counseling given to parents for this prenatal decision.

DESIGN:

Prospective study of neonates liveborn between 22 and 26 weeks of gestation in France in 2011 among the neonates included in the EPIPAGE-2 study.

SETTING:

18 centers participating in the "Extreme Prematurity Group" substudy of the EPIPAGE-2 study.

PATIENTS:

302 neonates liveborn between 22-26 weeks among which 113 with known parental preferences while parental preferences were unknown or unavailable for 186 and delivery room management was missing for 3.

RESULTS:

Data on prenatal counseling and parental preferences were collected by a questionnaire completed by professionals who cared for the baby at birth; delivery room (DR) management, classified as stabilization or initiation of resuscitation (SIR) vs comfort care (CC). The 113 neonates studied had a mean (SD) gestational age of 24 (0.1) weeks. Parents of neonates in the CC group preferred SIR less frequently than those with neonates in the SIR group (16% vs 88%, p < .001). After multivariate analysis, preference for SIR was an independent factor associated with this management. Professionals qualified decisions as shared (81%), exclusively medical (16%) or parental (3%). Information was described as medical with no personal opinion (71%), complete (75%) and generally pessimistic (54%).

CONCLUSION:

Parental involvement in prenatal decision-making did not reach satisfying rates in the studied setting. When available, prenatal parental preference was a determining factor for DR management of extremely preterm neonates. Potential biases in the content of prenatal counselling given to parents need to be evaluated.

PMID:
31465428
PMCID:
PMC6715208
DOI:
10.1371/journal.pone.0221859
[Indexed for MEDLINE]
Free PMC Article

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