Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Antenatal counseling in the gray zone of viability

Journal of Perinatology volume 40, pages 1797–1801 (2020)Cite this article

Subjects

Abstract

Objective

The objective of this study is to determine the resuscitation choices at 22–24 weeks gestation, related to whether mothers received antenatal counseling and the timing relative to delivery.

Study design

A retrospective chart review was performed of infants inborn at 22–24 weeks, over a 5-year period. Infants were excluded if they had major birth defects, were still hospitalized, or the consult occurred before 22 weeks.

Result

Of 121 infants born at 220–246 weeks, 91 were born to mothers who received a neonatology consult. For 80 infants resuscitated after consult, the median time between consult and delivery was 51.7 h (range: 0.1–366.3 h). For 11 infants who received comfort care after consult, the median time between consult and delivery was 20.0 h (range: 0.8–64.4 h).

Conclusions

After receiving counseling on the morbidity and mortality of delivery at 22–24 weeks, most parents chose resuscitation. Overall, 12–24 h between consult and delivery, parents were more likely to choose comfort care.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on SpringerLink
  • Instant access to the full article PDF.

USD 39.95

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Participant flow diagram.
Fig. 2: Estimated time between consult and delivery.
Fig. 3: Estimated time between consult and delivery.

Similar content being viewed by others

References

  1. Singh J, Fanaroff J, Andrews B, Caldarelli L, Lagatta J, Plesha-Troyke S, et al. Resuscitation in the “gray zone” of viability: determining physician preferences and predicting infant outcomes. Pediatrics. 2007;120:519–26.

    PubMed  Google Scholar 

  2. Younge N, Goldstein RF, Bann CM, Hintz SR, Patel RM, Smith PB, et al. Survival and neurodevelopmental outcomes among periviable infants. N Engl J Med. 2017;376:617–28.

    PubMed  PubMed Central  Google Scholar 

  3. Tyson JE, Parikh NA, Langer J, Green C, Higgins RD. Intensive care for extreme prematurity—moving beyond gestational age. N Engl J Med. 2008;358:1672–81.

    CAS  PubMed  PubMed Central  Google Scholar 

  4. Cummings J. Antenatal counseling regarding resuscitation and intensive care before 25 weeks of gestation. Pediatrics. 2015;136:588–95.

    PubMed  Google Scholar 

  5. Partridge JC, Dickey BJ. Decision-making in neonatal intensive care: interventions on behalf of preterm infants. NeoReviews. 2009;10:e270–9.

    Google Scholar 

  6. Raju TN, Mercer BM, Burchfield DJ, Joseph GF Jr. Periviable birth: executive summary of a joint workshop by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, American Academy of Pediatrics, and American College of Obstetricians and Gynecologists. Am J Obstet Gynecol. 2014;210:406–17.

    PubMed  Google Scholar 

  7. American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus No. 6: periviable birth. Obstet Gynecol. 2017;130:e187.

    Google Scholar 

  8. Kaempf JW, Tomlinson MW, Campbell B, Ferguson L, Stewart VT. Counseling pregnant women who may deliver extremely premature infants: medical care guidelines, family choices, and neonatal outcomes. Pediatrics. 2009;123:1509–15.

    PubMed  Google Scholar 

  9. Kukora S, Gollehon N, Laventhal N. Antenatal palliative care consultation: implications for decision-making and perinatal outcomes in a single-centre experience. Arch Dis Child Fetal Neonatal Ed. 2017;102:F12–6.

    PubMed  Google Scholar 

  10. Griswold KJ, Fanaroff JM. An evidence-based overview of prenatal consultation with a focus on infants born at the limits of viability. Pediatrics. 2010;125:e931–7.

    PubMed  Google Scholar 

  11. Janvier A, Lorenz JM, Lantos JD. Antenatal counselling for parents facing an extremely preterm birth: limitations of the medical evidence. Acta Paediatr. 2012;101:800–4.

    PubMed  Google Scholar 

  12. Guillén Ú, Suh S, Munson D, Posencheg M, Truitt E, Zupancic JA, et al. Development and pretesting of a decision-aid to use when counseling parents facing imminent extreme premature delivery. J Pediatr. 2012;160:382–7.

    PubMed  Google Scholar 

  13. Rysavy MA, Li L, Bell EF, Das A, Hintz SR, Stoll BJ, et al. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med. 2015;372:1801–11.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Bonnie Siner, RN, and Nancy Newman, RN, for their work in collecting institutional data, and Drs. Michelle Walsh and Jonathan Fanaroff for their review of the paper.

Funding

The only funding source to disclose is the institutional Clinical and Translational Science Award (CTSC, UL1TR002548), for use of REDCap.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, Rainbow Babies and Children’s Hospital, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Allison Osborne, Rebecca Fish & Kristin C. Voos

Authors
  1. Allison Osborne
    View author publications

    Search author on:PubMed Google Scholar

  2. Rebecca Fish
    View author publications

    Search author on:PubMed Google Scholar

  3. Kristin C. Voos
    View author publications

    Search author on:PubMed Google Scholar

Corresponding author

Correspondence to Allison Osborne.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Osborne, A., Fish, R. & C. Voos, K. Antenatal counseling in the gray zone of viability. J Perinatol 40, 1797–1801 (2020). https://doi.org/10.1038/s41372-020-00818-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Version of record:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41372-020-00818-5

Search

Advanced search

Quick links