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Item Development of a Theory-Informed Patient Decision Aid to Facilitate Consent to Genetic Testing in the Neonatal Intensive Care Unit(2024-05) Higley, Keeley; Head, Katharine J.; Brann, Maria; Bute, Jennifer J.Genetic testing is an essential diagnostic tool in the neonatal intensive care unit (NICU) that can shorten infants’ stays, improve accuracy and effectiveness of medical care, and overall improve quality of life. However, there are challenges involved in the process of recommending life-saving and care-changing genetic testing in the NICU, including parental concerns around issues of paternity, guardians’ decisional anxiety, low health literacy, limited understanding of genetic testing, and receiving conflicting information from different healthcare providers. These challenges are exacerbated by the urgency guardians face in the NICU; guardians’ first exposure to genetic testing often occurs immediately before they are asked to decline or consent to it while in an extremely emotional state and fraught environment, creating a sense of urgency that affects decision-making. Current patient-provider communication practices in the NICU could benefit from improved, streamlined communication tools to help guardians make thoughtful decisions about genetic testing for their hospitalized infants. One potential strategy to streamline communication about genetic testing in the NICU is incorporating self-determination theory into patient decision aids. A series of three iterative interview rounds with NICU guardians and new guardians of infants younger than three years old were conducted. Following each round of interviews, recordings were transcribed, and feedback from participants was used to revise a patient decision aid guided by self-determination theory. After completing all three rounds of interviews and revisions, thematic analysis was conducted on all transcribed interviews to identify salient themes to NICU genetic testing decision-making. The final version of the patient decision aid developed from this study will serve as a starting point for integrating this important tool into the NICU.Item Intention to treat: obstetrical management at the threshold of viability(Elsevier, 2020) Tonismae, Tiffany R.; Edmonds, Brownsyne Tucker; Bhamidipalli, Surya Sruthi; Fadel, William F.; Carlos, Christine; Andrews, Bree; Fritz, Katie A.; Leuthner, Steven R.; Lawrence, Christin; Laventhal, Naomi; Hayslett, Drew; Coleman, Tasha; Famuyide, Mobolaji; Feltman, Dalia; Obstetrics and Gynecology, School of MedicineBackground Despite medical advances in the care of extremely preterm neonates and growing acceptance of resuscitation at 23 and even 22 weeks gestation, controversy remains concerning the use of antepartum obstetric intervention s that are intended to improve outcomes in the setting of anticipated extremely preterm birth. In the absence of demonstrated benefit at <23 weeks gestation and with uncertain benefit at 23 weeks gestation, previous obstetric committee opinions have advised against their use at these gestational ages. Objective The purpose of this study was to review the use of obstetric intervention s at the threshold of viability based on neonatal resuscitation plan and to review the odds of survival to neonatal intensive care unit discharge based on use of obstetric intervention s with adjustment for neonatal factors. Study Design This retrospective study of 6 study centers reviewed pregnant patients who were admitted between 22+0/7 and 24+6/7 weeks gestation facing delivery from 2011–2015. Patients with known anomalies or missing data were excluded. Records were reviewed for demographics, resuscitation plan, and obstetric intervention s. Mode of delivery, delivery room care, and final infant dispositions were recorded. Multiple gestations were included as 1 pregnancy in regard to the use of obstetric intervention s and were excluded from survival analysis. Results Four hundred seventy-eight mothers met the inclusion criteria. When resuscitation was planned, mothers were more likely to receive all conventional obstetric intervention s (antenatal steroids, magnesium sulfate for neuroprotection, tocolytics, and Group Beta Streptococcus prophylaxis), regardless of gestational age at admission, and were more likely to be delivered by cesarean section (P<.05). Analyzed as a group, when antenatal steroids, magnesium sulfate, tocolytics and Group Beta Streptococcus prophylaxis were administered, the odds of survival to neonatal intensive care unit discharge increased for newborn infants who were born at 22 (odds ratio, 11.33; 95% confidence interval, 1.405–91.4) and 23 weeks gestation (odds ratio, 15.5; 95% confidence interval, 3.747-64.11; P<.05). In singletons, the odds of survival to neonatal intensive care unit discharge was not improved by cesarean delivery vs vaginal delivery, even after adjustment for the use of additional interventions, weight, gender, and gestational age (odds ratio, 1.0; 95% confidence interval, 0.59–1.8; P=.912). Conclusion In this study, when postnatal resuscitation was planned at 22 and 23 weeks gestation, women were more likely to receive antenatal steroids, magnesium sulfate, and antibiotics; provision of this bundle imparted survival benefit at 23 weeks gestation but could not be demonstrated at 22 weeks gestation because of the small sample size. These findings support of neonate-oriented obstetric interventions in the setting of delivery at 23 weeks gestation when resuscitation is planned and further exploration of optimal obstetric care when resuscitation of infants who were born at 22 weeks gestation is anticipated.Item Screening for postpartum depression: obligation and opportunity for pediatricians to improve the lives of children(Nature, 2019) Chambers, Joanna E.; Denne, Scott C.; Psychiatry, School of Medicine