Faculty Collaboration Database

Resuscitation in the "gray zone" of viability: determining physician preferences and predicting infant outcomes. Pediatrics 2007 Sep;120(3):519-26

Date

09/04/2007

Pubmed ID

17766524

DOI

10.1542/peds.2006-2966

Scopus ID

2-s2.0-34548442557 (requires institutional sign-in at Scopus site)   169 Citations

Abstract

OBJECTIVE: We assessed physician preferences and physician prognostic abilities regarding delivery room management of exceedingly low birth weight/short gestation infants.

METHODS: We surveyed US neonatologists to assess their behavior in the delivery room when confronted with infants with gestational ages of 22 to 26 weeks. We identified 102 infants in our NICU with birth weights/gestational ages of 400 g/23 weeks to 750 g/26 weeks, whose follow-up care was ensured because of their participation in ongoing clinical trials. We determined 4 proxy measures for "how the infant looked" in the delivery room (Apgar scores at 1 and 5 minutes and heart rates at 1 and 5 minutes) and assessed the predictive value of each marker for subsequent death or neurologic morbidity.

RESULTS: For infants with birth weights of < 500 g and gestational ages of 23 weeks, only 4% of 666 responding neonatologists would provide full resuscitation. In contrast, for infants with birth weights of > 600 g and gestational ages of 25 weeks, > 90% of neonatologists considered resuscitation obligatory. For infants with birth weights of 500 to 600 g and gestational ages of 23 to 24 weeks, only one third of neonatologists responded that parental preference would determine whether they resuscitated the infant in the delivery room. The majority wanted "to see what the infant looked like." For 102 infants with birth weights of < or = 750 g, Apgar scores at 1 and 5 minutes and heart rates at 1 and 5 minutes were neither sensitive nor predictive for death before discharge, survival with a neurologic abnormality, or intact neurologic survival.

CONCLUSIONS: The "gray zone" for delivery room resuscitation seems to be between 500 and 600 g and 23 and 24 weeks. For infants born in that zone, neonatologists' reliance on accurate prediction of death or morbidity in the delivery room may be misplaced.

Author List

Singh J, Fanaroff J, Andrews B, Caldarelli L, Lagatta J, Plesha-Troyke S, Lantos J, Meadow W

Author

Joanne M. Lagatta MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Apgar Score
Attitude of Health Personnel
Cardiopulmonary Resuscitation
Decision Making
Delivery Rooms
Gestational Age
Humans
Infant, Extremely Low Birth Weight
Infant, Newborn
Infant, Premature
Practice Patterns, Physicians'
ROC Curve
Sensitivity and Specificity
Surveys and Questionnaires
United States