Shifting Provider Attitudes and Institutional Resources Surrounding Resuscitation at the Limit of Gestational Viability
Shifting Provider Attitudes and Institutional Resources Surrounding Resuscitation at the Limit of Gestational Viability
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DOI：
10.1055/s-0040-1719071
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发表时间：
2020-10-27
影响因子：
2
通讯作者：
Dunbar, Alston E., III
中科院分区：
文献类型：
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作者：
Arbour, Kaitlyn;Lindsay, Elizabeth;Dunbar, Alston E., III
目的本研究旨在提供有关提供者对围生儿复苏和稳定的适当护理的看法以及提供者可用的机构资源的当代数据。研究设计一项质量调查通过公共数据库通过电子邮件发送给672名美国执业新生儿学家。参与者被问及22至26周出生婴儿的产房护理，影响决策的因素，以及复苏方面使用的资源。采用描述性统计方法对数据集进行分析。结果共收到问卷180份，分析173份。关于基于胎龄的首选护理方案，随着胎龄的降低，赞成完全复苏的受访者比例下降（25周= 99%,24 = 64%,23 = 16%,22 = 4%）。遵从父母意愿的比例随着胎龄的降低而增加（25周= 1%，24周= 35%，23周= 82%，22周= 46%）。提供舒适护理仅在22至23周时被认可（23周= 2%,22 = 50%）。在孕22周时对决策影响最大的因素包括：基于人口数据的结果（79%）、父母意愿（65%）和生活质量测量（63%）。采用2.5 mm气管内插管（84%）、在产房给予表面活性剂（77%）和血管通路（69%）是最受支持的初始稳定治疗方法。可获得的机构资源各不相同；最受限制的是生存能力极限剖宫产的产科支持（37%），2.0 mm气管内管（45%），小婴儿方案（46%）和咨询姑息治疗团队（54%）。结论在23周和22周时，医护人员对首选措施的态度存在差异。提供者对生存能力极限下的决策和确定的资源限制的态度是不一致的。围生儿结果的医院间差异可能部分归因于缺乏提供者共识和各机构间资源可得性不统一。
Objective This study aimed to provide contemporary data regarding provider perceptions of appropriate care for resuscitation and stabilization of periviable infants and institutional resources available to providers.Study Design A Qualtrics survey was emailed to 672 practicing neonatologists in the United States by use of public databases. Participants were asked about appropriate delivery room care for infants born at 22 to 26 weeks gestational age, factors affecting decision-making, and resources utilized regarding resuscitation. Descriptive statistics were used to analyze the dataset.Results In total, 180 responses were received, and 173 responses analyzed. Regarding preferred course of care based on gestational age, the proportion of respondents endorsing full resuscitation decreased with decreasing gestational age (25 weeks = 99%, 24 = 64%, 23 = 16%, and 22 = 4%). Deference to parental wishes correspondingly increased with decreasing gestational age (25 weeks = 1%, 24 = 35%, 23 = 82%, and 22 = 46%). Provision of comfort care was only endorsed at 22 to 23 weeks (23 weeks = 2%, 22 = 50%). Factors most impacting decision-making at 22 weeks gestational age included: outcomes based on population data (79%), parental wishes (65%), and quality of life measures (63%). Intubation with a 2.5-mm endotracheal tube (84%), surfactant administration in the delivery room (77%), and vascular access (69%) were the most supported therapies for initial stabilization. Availability of institutional resources varied; the most limited were obstetric support for cesarean delivery at the limit of viability (37%), 2.0-mm endotracheal tube (45%), small baby protocols (46%), and a consulting palliative care teams (54%).Conclusion There appears to be discordance in provider attitudes surrounding preferred actions at 23 and 22 weeks. Provider attitudes regarding decision-making at the limit of viability and identified resource limitations are nonuniform. Between-hospital variations in outcomes for periviable infants may be partly attributable to lack of provider consensus and nonuniform resource availability across institutions.