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

Cerise Levaillant,Barthélémy Tosello,Olivier Claris,On Behalf Of The Epipage 2 Extreme Prematurity Group ,Caroline Diguisto,Elie Azria,Hélène Béhal,Laurence Caeymaex,Monique Kaminski,Pierre Bétrémieux,Patrick Truffert,Laurence Foix L’Hélias

doi:10.1371/journal.pone.0221859

Abstract

ObjectiveOur 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.DesignProspective study of neonates liveborn between 22 and 26 weeks of gestation in France in 2011 among the neonates included in the EPIPAGE-2 studySetting18 centers participating in the “Extreme Prematurity Group” substudy of the EPIPAGE-2 study.Patients302 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.ResultsData 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%).ConclusionParental 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.

Highlights

Low gestational age neonates account for 0.3% of live births in France [1]
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)
Parents of neonates in the CC group preferred SIR less frequently than those with neonates in the SIR group (16% vs 88%, p < .001)

Summary

Introduction

Low gestational age neonates (between 22 and 26 weeks) account for 0.3% of live births in France [1]. Several studies have described their mortality and sequelae, showing that active perinatal care increases survival but is associated with neurodevelopmental disability among survivors [2,3,4,5]. These studies, describing outcomes for extremely preterm infants as a group, call into question any systematic policy of delivery room (DR) management at these gestational ages (GA). Emotions play a role in this decision-making process during the periviable period—for both parents and physicians Studies show that both the framing and communication of information determine the parents’ mental picture and influence their perception of the most appropriate decision [19,20]

Methods

Results

Conclusion