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.