Am J Perinatol 2017; 34(13): 1279-1285
DOI: 10.1055/s-0037-1603317
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

How Are Neonatology Fellows Trained for Antenatal Periviability Counseling?

Dalia M. Feltman
1   Division of Neonatology, Department of Pediatrics, Evanston Hospital, NorthShore University HealthSystem, Evanston, Illinois
2   Pritzker School of Medicine, University of Chicago, Chicago, Illinois
David D. Williams
3   Health Services & Outcomes Research, Children's Mercy Hospital, University of Missouri–Kansas City, Kansas City, Missouri
Brian S. Carter
4   Departments of Neonatology & Bioethics, Children's Mercy Hospital, University of Missouri–Kansas City, Kansas City, Missouri
› Author Affiliations
Further Information

Publication History

30 January 2017

05 April 2017

Publication Date:
12 May 2017 (online)


Background Studies have shown rates of life-sustaining treatments for periviable newborns vary by center, centers' differing periviability approaches affect trainees' views, and formal communication training for neonatology fellows is uncommon. Parents of imperiled newborns report unmet emotional and spiritual needs. This study sought to understand how fellows learn to support parents and their periviable newborns through exposure to institutional clinical approaches and by formal curriculum.

Methods All the U.S. neonatology fellowship program directors were invited to complete an online anonymous survey. Data were analyzed with descriptive statistics.

Results In this study, 56 of 98 directors (57%) responded. Training centers differed in delivery room options offered and recommended for periviable newborns. Providing parents written information and neonatology and obstetrics co-counseling were uncommon. Directors reported weaknesses in training fellows to support parents' spiritual and emotional needs, and < 50% reported formal policies for involving social workers or chaplain. Fellows learned periviability counseling in 95% programs by observing attending physicians; however, only 54% directors reported typical joint daytime counseling with fellows and attending physicians.

Conclusion Training programs exposed fellows to different periviability care approaches, identified weaknesses in teaching support provision for parents' needs, and appeared to miss opportunities for clinical modeling of counseling and comfort care provision.

  • References

  • 1 Cummings J. ; Committee on Fetus and Newborn. Antenatal counseling regarding resuscitation and intensive care before 25 weeks of gestation. Pediatrics 2015; 136 (03) 588-595
  • 2 Rysavy MA, Li L, Bell EF. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med 2015; 372 (19) 1801-1811
  • 3 Janvier A, Barrington K, Deschênes M, Couture E, Nadeau S, Lantos J. Relationship between site of training and residents' attitudes about neonatal resuscitation. Arch Pediatr Adolesc Med 2008; 162 (06) 532-537
  • 4 Raju TN, Mercer BM, Burchfield DJ, Joseph GF. 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. J Perinatol 2014; 34 (05) 333-342
  • 5 Gallagher K, Martin J, Keller M, Marlow N. European variation in decision-making and parental involvement during preterm birth. Arch Dis Child Fetal Neonatal Ed 2014; 99 (03) F245-F249
  • 6 Duffy D, Reynolds P. Babies born at the threshold of viability: attitudes of paediatric consultants and trainees in South East England. Acta Paediatr 2011; 100 (01) 42-46
  • 7 Barton L, Hodgman JE. The contribution of withholding or withdrawing care to newborn mortality. Pediatrics 2005; 116 (06) 1487-1491
  • 8 Kaempf JW, Tomlinson MW, Tuohey J. Extremely premature birth and the choice of neonatal intensive care versus palliative comfort care: an 18-year single-center experience. J Perinatol 2016; 36 (03) 190-195
  • 9 Arzuaga BH, Cummings CL. Practices and education surrounding anticipated periviable deliveries among neonatal-perinatal medicine and maternal-fetal medicine fellowship programs. J Perinatol 2016; 36 (09) 699-703
  • 10 Boss RD, Hutton N, Donohue PK, Arnold RM. Neonatologist training to guide family decision making for critically ill infants. Arch Pediatr Adolesc Med 2009; 163 (09) 783-788
  • 11 Gaucher N, Nadeau S, Barbier A, Janvier A, Payot A. Personalized antenatal consultations for preterm labor: responding to mothers' expectations. J Pediatr 2016; 178: 130-134.e7
  • 12 Janvier A, Barrington K, Farlow B. Communication with parents concerning withholding or withdrawing of life-sustaining interventions in neonatology. Semin Perinatol 2014; 38 (01) 38-46
  • 13 Brooten D, Youngblut JM, Seagrave L. , et al. Parent's perceptions of health care providers actions around child ICU death: what helped, what did not. Am J Hosp Palliat Care 2013; 30 (01) 40-49
  • 14 Wigert H, Dellenmark MB, Bry K. Strengths and weaknesses of parent-staff communication in the NICU: a survey assessment. BMC Pediatr 2013; 13: 71 . Doi: 10.1186/1471-2431-13-71
  • 15 Stokes TA, Watson KL, Boss RD. Teaching antenatal counseling skills to neonatal providers. Semin Perinatol 2014; 38 (01) 47-51
  • 16 Arzuaga BH, Caldarelli L. Paediatric trainees and end-of-life care: a needs assessment for a formal educational intervention. Perspect Med Educ 2015; 4 (01) 25-32
  • 17 Bry K, Bry M, Hentz E. , et al. Communication skills training enhances nurses' ability to respond with empathy to parents' emotions in a neonatal intensive care unit. Acta Paediatr 2016; 105 (04) 397-406
  • 18 Phibbs CS, Baker LC, Caughey AB, Danielsen B, Schmitt SK, Phibbs RH. Level and volume of neonatal intensive care and mortality in very-low-birth-weight infants. N Engl J Med 2007; 356 (21) 2165-2175
  • 19 Tucker Edmonds B, McKenzie F, Panoch JE, Barnato AE, Frankel RM. Comparing obstetricians' and neonatologists' approaches to periviable counseling. J Perinatol 2015; 35 (05) 344-348
  • 20 Ramsay SM, Santella RM. The definition of life: a survey of obstetricians and neonatologists in New York City hospitals regarding extremely premature births. Matern Child Health J 2011; 15 (04) 446-452
  • 21 Mehrotra A, Lagatta J, Simpson P, Kim UO, Nugent M, Basir MA. Variations among US hospitals in counseling practices regarding prematurely born infants. J Perinatol 2013; 33 (07) 509-513
  • 22 White DB, Braddock III CH, Bereknyei S, Curtis JR. Toward shared decision making at the end of life in intensive care units: opportunities for improvement. Arch Intern Med 2007; 167 (05) 461-467
  • 23 King CP, da Silva O, Filler G, Lopes LM. Online calculator to improve counseling of short-term neonatal morbidity and mortality outcomes at extremely low gestational age (23–28 weeks). Am J Perinatol 2016; 33 (09) 910-917