Chief Resident UT Southwestern/Children's Health Dallas, Texas, United States
Background: Significant hospital variation surrounding resuscitation for periviable infants exists. Individual preferences concerning resuscitation at the limit of viability are not consistent and preferred management plans differ between providers. The impact of NICU culture and patient population on these preferences is not well understood. The UT Southwestern Division of Neonatal-Perinatal Medicine staffs three distinct NICUs serving different patient populations. Parkland Memorial Hospital (PMH), a public hospital with a large level 3 NICU and primary teaching facility, Clements University Hospital (CUH), a level 3 NICU in an academic hospital, and Texas Health Presbyterian Hospital (THD), a level 3 NICU in a community hospital. Our division began routinely offering resuscitation at 22 weeks gestational age in 2021 with no standardized counseling guidelines. Objective: To evaluate the impact of facility/NICU type on provider and staff preferences surrounding the resuscitation of infants at 22wks GA. Design/Methods: An anonymous 21 question redcap survey focused on preferences surrounding resuscitation at 22wk GA, antenatal counseling strategies and factors impacting decision making was provided to staff and providers at PMH, CUH and THD. Individuals surveyed include Neonatology and OB/MFM Attendings, Advanced Practice Providers, NICU and Labor & Delivery RNs and respiratory therapists. IRB approval was obtained. There were 251 responses with 43% from PMH, 37% from CUH and 20% from THD. Preliminary data analysis shows variation between hospitals regarding the best approach to resuscitation decisions with 71% supporting deferring to parental wishes at THD vs 61% at CUH and 48% at PMH. In addition, variation regarding the appropriateness of chest compressions/epinephrine in this population was noted with 47% at CUH considering this an option vs 33% at THD and 24% at PMH. Statistical analysis is currently underway.
