Am J Perinatol 2017; 34(08): 787-794
DOI: 10.1055/s-0037-1598247
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Influence of Maternal Factors in Neonatologists' Counseling for Periviable Pregnancies

Melissa D. Kunkel
1   Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
,
Stephen M. Downs
1   Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
,
Brownsyne Tucker Edmonds
2   Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
› Author Affiliations
Further Information

Publication History

15 July 2016

06 January 2017

Publication Date:
13 February 2017 (online)

Abstract

Background Neonatologists have varying counseling practices for women with threatened periviable pregnancies. Previous research has suggested this variability may be influenced by social and economic factors of the mother.

Objective The objective of this study was to determine the relative influence of maternal factors in counseling recommendations for periviable pregnancies.

Methods A national cohort of neonatologists was sent a web-based survey. Five maternal characteristics were varied across eight vignettes: age, education, race, parity, and pregnancy “intendedness.” Following each vignette, participants reported their likelihood to recommend full resuscitation versus comfort care. Conjoint analysis was used to assess the relative influence of each factor on respondents' recommendations.

Results Responses from 328 neonatologists were included. Of the five tested maternal characteristics, parity and intendedness had the highest importance scores (40.2 and 35.0), followed by race, education, and age. If parents requested resuscitation, respondents were highly likely to comply with preferences, with little variation across vignettes.

Conclusion Fetal-specific factors such as gestational age and estimated weight are known to influence counseling and decision making for extremely preterm infants. Our results suggest that maternal factors may also influence counseling practices, although physicians are likely to comply with parental preferences regardless of maternal factors. Future research should identify how maternal characteristics impact actual counseling practices.

Note

The first draft was written by Dr. Melissa Kunkel. No authors received any honorarium, grant, or other form of payment to produce the article.


 
  • References

  • 1 Stoll BJ, Hansen NI, Bell EF. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126 (03) 443-456
  • 2 Hintz SR, Kendrick DE, Wilson-Costello DE. , et al; NICHD Neonatal Research Network. Early-childhood neurodevelopmental outcomes are not improving for infants born at <25 weeks' gestational age. Pediatrics 2011; 127 (01) 62-70
  • 3 Mercier CE, Dunn MS, Ferrelli KR, Howard DB, Soll RF. ; Vermont Oxford Network ELBW Infant Follow-Up Study Group. Neurodevelopmental outcome of extremely low birth weight infants from the Vermont Oxford Network: 1998-2003. Neonatology 2010; 97 (04) 329-338
  • 4 Aarnoudse-Moens CS, Weisglas-Kuperus N, van Goudoever JB, Oosterlaan J. Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. Pediatrics 2009; 124 (02) 717-728
  • 5 Weiss AR, Binns HJ, Collins Jr JW, deRegnier RA. Decision-making in the delivery room: a survey of neonatologists. J Perinatol 2007; 27 (12) 754-760
  • 6 Tyson JE, Parikh NA, Langer J, Green C, Higgins RD. ; National Institute of Child Health and Human Development Neonatal Research Network. Intensive care for extreme prematurity--moving beyond gestational age. N Engl J Med 2008; 358 (16) 1672-1681
  • 7 Bader D, Kugelman A, Boyko V. , et al; Israel Neonatal Network. Risk factors and estimation tool for death among extremely premature infants: a national study. Pediatrics 2010; 125 (04) 696-703
  • 8 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
  • 9 Carlo WA, McDonald SA, Fanaroff AA. , et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks' gestation. JAMA 2011; 306 (21) 2348-2358
  • 10 Tucker Edmonds B, Fager C, Srinivas S, Lorch S. Racial and ethnic differences in use of intubation for periviable neonates. Pediatrics 2011; 127 (05) e1120-e1127
  • 11 Laskey AL, Stump TE, Perkins SM, Zimet GD, Sherman SJ, Downs SM. Influence of race and socioeconomic status on the diagnosis of child abuse: a randomized study. J Pediatr 2012; 160 (06) 1003-1008.e1
  • 12 Mack JW, Paulk ME, Viswanath K, Prigerson HG. Racial disparities in the outcomes of communication on medical care received near death. Arch Intern Med 2010; 170 (17) 1533-1540
  • 13 Orme BK. Getting Started with Conjoint Analysis: Strategies for Product Design and Pricing Research, 2nd ed. Madison, WI: Research Publishers; 2010
  • 14 Edmonds BT, McKenzie F, Hendrix KS, Perkins SM, Zimet GD. The influence of resuscitation preferences on obstetrical management of periviable deliveries. J Perinatol 2015; 35 (03) 161-166
  • 15 Stockwell MS, Rosenthal SL, Sturm LA, Mays RM, Bair RM, Zimet GD. The effects of vaccine characteristics on adult women's attitudes about vaccination: a conjoint analysis study. Vaccine 2011; 29 (27) 4507-4511
  • 16 Pisa G, Eichmann F, Hupfer S. Assessing patient preferences in heart failure using conjoint methodology. Patient Prefer Adherence 2015; 9: 1233-1241
  • 17 Marcello KR, Stefano JL, Lampron K, Barrington KJ, Mackley AB, Janvier A. The influence of family characteristics on perinatal decision making. Pediatrics 2011; 127 (04) e934-e939
  • 18 Bertrand M, Mullainathan S. Are Emily and Greg more employable than Lakisha and Jamal? A field experiment on labor market discrimination. Am Econ Rev 2004; 94 (04) 991-1013
  • 19 Butler DM, Broockman DE. Do politicians racially discriminate against constituents? A field experiment on state legislators. Am J Pol Sci 2011; 55 (03) 463-477
  • 20 King EB, Madera JM, Hebl MR, Knight JL, Mendoza SA. What's in a name? A multiracial investigation of the role of occupational stereotypes in selection decisions. J Appl Soc Psychol 2006; 36 (05) 1145-1159
  • 21 Carpusor AG, Loges WE. Rental discrimination and ethnicity in names. J Appl Soc Psychol 2006; 36 (04) 934-952
  • 22 Word DL, Coleman CD, Nunziata R, Kominski R. Demographic aspects of surnames from Census 2000. Technical Report for the U.S. Census Bureau. Available at: http://www2.census.gov/topics/genealogy/2000surnames/surnames.pdf . Accessed August 24, 2015
  • 23 Hair JF. Multivariate Data Analysis with Readings, 4th ed. Englewood Cliffs, NJ: Prentice Hall; 1995
  • 24 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
  • 25 Peerzada JM, Richardson DK, Burns JP. Delivery room decision-making at the threshold of viability. J Pediatr 2004; 145 (04) 492-498
  • 26 Tucker Edmonds B, McKenzie F, Farrow V, Raglan G, Schulkin J. A national survey of obstetricians' attitudes toward and practice of periviable intervention. J Perinatol 2015; 35 (05) 338-343
  • 27 Tomlinson MW, Kaempf JW, Ferguson LA, Stewart VT. Caring for the pregnant woman presenting at periviable gestation: acknowledging the ambiguity and uncertainty. Am J Obstet Gynecol 2010; 202 (06) 529.e1-529.e6
  • 28 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 (06) 1509-1515
  • 29 Tucker Edmonds B, Krasny S, Srinivas S, Shea J. Obstetric decision-making and counseling at the limits of viability. Am J Obstet Gynecol 2012; 206 (03) 248.e1-248.e5
  • 30 Minkoff HL, Berkowitz R. The myth of the precious baby. Obstet Gynecol 2005; 106 (03) 607-609
  • 31 Haward MF, Murphy RO, Lorenz JM. Default options and neonatal resuscitation decisions. J Med Ethics 2012; 38 (12) 713-718
  • 32 Haward MF, Murphy RO, Lorenz JM. Message framing and perinatal decisions. Pediatrics 2008; 122 (01) 109-118
  • 33 Tucker Edmonds B, Fager C, Srinivas S, Lorch S. Predictors of cesarean delivery for periviable neonates. Obstet Gynecol 2011; 118 (01) 49-56
  • 34 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
  • 35 Johnson TJ, Weaver MD, Borrero S. , et al. Association of race and ethnicity with management of abdominal pain in the emergency department. Pediatrics 2013; 132 (04) e851-e858
  • 36 Boss RD, Hutton N, Sulpar LJ, West AM, Donohue PK. Values parents apply to decision-making regarding delivery room resuscitation for high-risk newborns. Pediatrics 2008; 122 (03) 583-589
  • 37 Boss RD, Henderson CM, Wilfond BS. Decisions regarding resuscitation of extremely premature infants: should social context matter?. JAMA Pediatr 2015; 169 (06) 521-522
  • 38 Bastek TK, Richardson DK, Zupancic JA, Burns JP. Prenatal consultation practices at the border of viability: a regional survey. Pediatrics 2005; 116 (02) 407-413
  • 39 Shih TH, Fan XT. Comparing response rates from Web and mail surveys: a meta-analysis. Field Methods 2008; 20 (03) 249-271
  • 40 Golnik A, Ireland M, Borowsky IW. Medical homes for children with autism: a physician survey. Pediatrics 2009; 123 (03) 966-971
  • 41 Dykema J, Jones NR, Piché T, Stevenson J. Surveying clinicians by web: current issues in design and administration. Eval Health Prof 2013; 36 (03) 352-381