Date of Award

January 2017

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Mark R. Mercurio

Second Advisor

Alaina Pyle

Abstract

The purpose of this study is to determine factors associated with parental request for aggressive resuscitation for infants born at borderline viability, the period between 22 0/7 and 24 6/7 weeks of gestation. Between 2013 and 2016, 81 women were admitted to Yale New Haven Hospital (YNHH) for a potential delivery in this critical period. Eighty-four percent of patients elected aggressive resuscitation for their newborn and 16% chose comfort care only. Using bivariate analysis to evaluate statistical significance, 5 of 19 possible variables were included in our logistic regression model. This model demonstrated higher likelihood of a request for resuscitation in patients who did not receive steroids or had multiple gestation. The odds of the request for resuscitation is threefold greater with each increase in gestational age by one day.

In a secondary study, a 15-item survey was administered to the current YNHH Neonatal-Perinatal fellows to evaluate the nature of the prenatal consult and the fellow’s recommendations for management of infants born in the gray zone. All five respondents recommend against resuscitation at 22 weeks, 80% recommend full resuscitation at 24 weeks and most prefer a case-by-case consideration at 23 weeks.

These findings stress the importance of frequent re-evaluation of patient choice for newborn management in borderline viable births as this may change with each additional day of pregnancy. Our study has important implications for the decision-making process between expectant parents, neonatologists, and obstetricians.

Comments

This is an Open Access Thesis.

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