Naomi Laventhal - Academia.edu (original) (raw)

Papers by Naomi Laventhal

Research paper thumbnail of The Prediction and Cost of Futility in the NICU

Acta Paediatrica, 2012

Aim-To quantify the cost and prediction of futile care in the Neonatal Intensive Care Unit (NICU)... more Aim-To quantify the cost and prediction of futile care in the Neonatal Intensive Care Unit (NICU). Methods-We observed 1813 infants on 100 000 NICU bed days between 1999 and 2008 at the University of Chicago. We determined costs and assessed predictions of futility for each day the infant required mechanical ventilation. Results-Only 6% of NICU expenses were spent on nonsurvivors, and in this sense, they were futile. If only money spent after predictions of death is considered, futile expenses fell to 4.5%. NICU care was preferentially directed to survivors for even the smallest infants, at the highest risk to die. Over 75% of ventilated NICU infants were correctly predicted to survive on every day of ventilation by every caretaker. However, predictions of 'die before discharge' were wrong more than one time in three. Attendings and neonatology fellows tended to be optimistic, while nurses and neonatal nurse practitioners tended to be pessimistic. Conclusions-Criticisms of the expense of NICU care find little support in these data. Rather, NICU care is remarkably well targeted to patients who will survive, particularly when contrasted with care in adult ICUs. We continue to search for better prognostic tools for individual infants.

Research paper thumbnail of Negative Studies and the Future of Prenatal Counseling at the Margin of Gestational Viability

The Journal of Pediatrics

Research paper thumbnail of When Do Pediatricians Call the Ethics Consultation Service? Impact of Clinical Experience and Formal Ethics Training

AJOB Empirical Bioethics, 2020

Background: Previous research shows that pediatricians inconsistently utilize the ethics consulta... more Background: Previous research shows that pediatricians inconsistently utilize the ethics consultation service (ECS). Methods: Pediatricians in two suburban, Midwestern academic hospitals were asked to reflect on their ethics training and utilization of ECS via an anonymous, electronic survey distributed in 2017 and 2018, and analyzed in 2018. Participants reported their clinical experience, exposure to formal and informal ethics training, use of formal and informal ethics consultations, and potential barriers to formal consultation. Results: Less experienced pediatricians were more likely to utilize formal ethics consultation and more likely to have formal ethics training. The most commonly reported reasons not to pursue formal ECS consultation were inconvenience and self-reported expertise in pediatric ethics. Conclusions: These results inform ongoing discussions about ethics consultation among pediatricians and the role of formal ethics training in both undergraduate and graduate medical education.

Research paper thumbnail of International variations in application of the best-interest standard across the age spectrum

Journal of Perinatology, 2016

Objective: Ethically and legally, assertions that resuscitation is in a patient's best interest s... more Objective: Ethically and legally, assertions that resuscitation is in a patient's best interest should be inversely correlated with willingness to forego intensive care (and accept comfort care) at the surrogate's request. Previous single country studies have demonstrated a relative devaluation of neonates when compared with other critically ill patients.

Research paper thumbnail of Who tells a mother her baby has died? Communication and staff presence during stillbirth delivery and early infant death

Journal of Perinatology, 2017

Perinatal loss (stillbirth or early infant death) is often a sudden, unexpected event for familie... more Perinatal loss (stillbirth or early infant death) is often a sudden, unexpected event for families. We evaluated who communicates the loss to the parents and who is there for support at the delivery or death. STUDY DESIGN: We conducted a mail survey of 900 bereaved and 500 live-birth mothers to assess emotional, physical and reproductive health outcomes. RESULTS: We had a 44% response rate at 9 months after birth or loss from 377 bereaved mothers and 232 with surviving infants. Bereaved women were less likely to have hospital staff or family members present at delivery. African-American (versus Caucasian) mothers were half as likely to have first heard about their stillbirth from a physician or midwife. CONCLUSION: This is the first large study documenting who communicates perinatal death to families and who is present for support. Hospitals should be aware that many bereaved families may lack support at critical times.

Research paper thumbnail of Contemporary and diverse approaches to perinatal ethics

Seminars in Fetal and Neonatal Medicine

Research paper thumbnail of Consultative Service Utilization Around Periviable Deliveries

Pediatrics, 2019

INTRODUCTION Multiple factors play important roles in decision-making regarding delivery room res... more INTRODUCTION Multiple factors play important roles in decision-making regarding delivery room resuscitation in periviable infants. Studies have shown that practice variability exists between neonatologists and maternal fetal medicine specialists with respect to how periviable antenatal consultations are conducted. However, there is no data to date reporting utilization of other consultative services, or provider billing practices around periviable deliveries. METHODS: Inborn periviable births in 2013-2015 at 6 centers were reviewed retrospectively. Mothers/babies admitted with living fetuses for unplanned periviable delivery and born at 22 0/7 to 24 6/7 weeks gestational …

Research paper thumbnail of Parent Preferences for Neonatal Intensive Care Unit Physician Attire: A Cross-Sectional Study

American journal of perinatology, 2021

OBJECTIVE Physician attire may influence the parent-provider relationship. Previous studies in a... more OBJECTIVE Physician attire may influence the parent-provider relationship. Previous studies in adult and outpatient pediatrics showed that formal attire with a white coat was preferred. We aimed to describe parent preferences for physician attire in the neonatal intensive care unit (NICU). STUDY DESIGN We surveyed 101 parents in a level IV NICU. The survey included photographs of a physician in seven different attires. Attire was scored in five domains and parents selected the most preferred attire in different contexts. All attires were compared with formal attire with white coat. Descriptive statistics, Fisher's exact tests, and one-way analysis of variance were used to compare parent responses. RESULTS Scrubs without white coat (40.8 [7.0]) and formal attire without white coat (39.7 [8.0]) had the highest mean (standard deviation) composite preference scores. However, no significant differences between formal attire with white coat (37.1 [9.0]) versus any other attire were...

Research paper thumbnail of Prognostic Value of Clinicians' Predictions of Neonatal Outcomes in Counseling at the Margin of Gestational Viability

Seminars in Perinatology

Within antenatal counseling sessions at the margin of gestational viability, clinicians frequentl... more Within antenatal counseling sessions at the margin of gestational viability, clinicians frequently to use population-based outcome data and statistical models to guide the decision-making process. These tools often utilize non-modifiable prenatal factors to estimate outcomes based on population averages. However, most parents prefer individualized predictions, which cannot be supported by these models. Additionally, prognostic accuracy is limited by institutional practices surrounding active management of infants at the margin of viability. Throughout the literature, parental perspectives emphasize the importance of communicating subjective information, such as providing hope and supporting personal values, over the importance of accurate prognostic information from the clinician. In this review we aim to describe the value of clinician prognoses in the decision-making process at the margin of gestational viability and emphasize the importance of addressing parental values during the counseling process, regardless of the expected outcome.

Research paper thumbnail of Perinatal Counseling at the Margin of Gestational Viability: Where We’ve Been, Where We’re Going, and How to Navigate a Path Forward

The Journal of Pediatrics

Research paper thumbnail of Hospital Visitation Policies During the SARS-CoV-2 Pandemic

American Journal of Infection Control

A significant change for patients and families during SARs-CoV-2 has been the restriction of visi... more A significant change for patients and families during SARs-CoV-2 has been the restriction of visitors for hospitalized patients. We analyzed SARs-CoV-2 hospital visitation policies and found widespread variation in both development and content. This variation has the potential to engender inequity in access. We propose guidance for hospital visitation policies for this pandemic to protect, respect, and support patients, visitors, clinicians, and communities.

Research paper thumbnail of The impact of the COVID-19 pandemic on children with autism spectrum disorders

Journal of Pediatric Rehabilitation Medicine

In the unprecedented disruption and social isolation of the COVID-19 pandemic, families around th... more In the unprecedented disruption and social isolation of the COVID-19 pandemic, families around the world are faced with questions of how their children can thrive in these conditions. On top of the ubiquitous challenges for all children, this public health crisis imparts unique difficulties for children with special health needs. We identify children with Autism Spectrum Disorder (ASD) as being particularly vulnerable to negative impacts of the COVID-19 pandemic. In this paper, we examine why children with ASD are uniquely vulnerable, recommend strategies to mitigate these stressors for children with ASD and their parents, explore the potential challenges of reintegration into society as conditions improve, and examine the obligations of healthcare and community stakeholders to support these families.

Research paper thumbnail of Visitor Guidelines in US Children’s Hospitals During COVID-19

Hospital Pediatrics

OBJECTIVES: To examine visitor guidelines among children’s hospitals in the United States in resp... more OBJECTIVES: To examine visitor guidelines among children’s hospitals in the United States in response to the coronavirus 2019 (COVID-19) pandemic. METHODS: A retrospective assessment of visitor guidelines in 239 children’s hospitals in the United States. RESULTS: In this study, we present an analysis of 239 children’s hospital visitor guidelines posted to hospitals’ Web sites during 1 week in June 2020. Of the 239 hospitals, only 28 did not have posted guidelines for review. The guidelines were analyzed and grouped by how the guidelines were updated in response to COVID-19. Parental visitation was restricted to 1 parent in 116 of the posted guidelines (49%). There were no obvious similarities among guidelines associated with their geographical (eg, state or local) location. As of February 2021, 33 of 55 (60%) randomly selected hospitals had not changed their visitor policy since our initial review. CONCLUSIONS: The COVID-19 pandemic triggered changes in publicly reported visitor gui...

Research paper thumbnail of The Ethics of Creating a Resource Allocation Strategy During the COVID-19 Pandemic

Pediatrics

The coronavirus disease 2019 pandemic has affected nearly every aspect of medicine and raises num... more The coronavirus disease 2019 pandemic has affected nearly every aspect of medicine and raises numerous moral dilemmas for clinicians. Foremost of these quandaries is how to delineate and implement crisis standards of care and, specifically, how to consider how health care resources should be distributed in times of shortage. We review basic principles of disaster planning and resource stewardship with ethical relevance for this and future public health crises, explore the role of illness severity scoring systems and their limitations and potential contribution to health disparities, and consider the role for exceptionally resource-intensive interventions. We also review the philosophical and practical underpinnings of crisis standards of care and describe historical approaches to scarce resource allocation to offer analysis and guidance for pediatric clinicians. Particular attention is given to the impact on children of this endeavor. Although few children have required hospitalizat...

Research paper thumbnail of Flattening the Rationing Curve: The Need for Explicit Guidelines for Implicit Rationing during the COVID-19 Pandemic

The American Journal of Bioethics

Patients, the public, and especially the health professionals potentially confronting painful tri... more Patients, the public, and especially the health professionals potentially confronting painful triage decisions deserve to know whether these decisions are, in fact, "saving the most lives."

Research paper thumbnail of Should Extremely Premature Babies Get Ventilators During the COVID-19 Crisis?

The American Journal of Bioethics

In a crisis, societal needs take precedence over a patient's best interests. Triage guidelines, h... more In a crisis, societal needs take precedence over a patient's best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. But surviving babies will likely live longer, maximizing lifeyears. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When "triaging" or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies.

Research paper thumbnail of Shifting Provider Attitudes and Institutional Resources Surrounding Resuscitation at the Limit of Gestational Viability

American Journal of Perinatology

Objective This study aimed to provide contemporary data regarding provider perceptions of appropr... more Objective This study aimed to provide contemporary data regarding provider perceptions of appropriate care for resuscitation and stabilization of periviable infants and institutional resources available to providers. Study Design A Qualtrics survey was emailed to 672 practicing neonatologists in the United States by use of public databases. Participants were asked about appropriate delivery room care for infants born at 22 to 26 weeks gestational age, factors affecting decision-making, and resources utilized regarding resuscitation. Descriptive statistics were used to analyze the dataset. Results In total, 180 responses were received, and 173 responses analyzed. Regarding preferred course of care based on gestational age, the proportion of respondents endorsing full resuscitation decreased with decreasing gestational age (25 weeks = 99%, 24 = 64%, 23 = 16%, and 22 = 4%). Deference to parental wishes correspondingly increased with decreasing gestational age (25 weeks = 1%, 24 = 35%, ...

Research paper thumbnail of Professional Obligations of Clinicians and Institutions in Pediatric Care Settings during a Public Health Crisis: A Review

The Journal of Pediatrics

Research paper thumbnail of Ethical decision-making for children with neuromuscular disorders in the COVID-19 crisis

Neurology

The sudden appearance and proliferation of COVID-19 has forced societies and governmental authori... more The sudden appearance and proliferation of COVID-19 has forced societies and governmental authorities across the world to confront the possibility of resource constraints when critical care facilities are overwhelmed by the sheer numbers of grievously ill patients. As governments and health care systems develop and update policies and guidelines regarding the allocation of resources, patients and families affected by chronic disabilities, including many neuromuscular disorders that affect children and young adults, have become alarmed at the possibility that they may be determined to have less favorable prognoses due to their underlying diagnoses and thus be assigned to lower priority groups. It is important for health care workers, policymakers, and government officials to be aware that the long term prognoses for children and young adults with neuromuscular disorders are often more promising than previously believed, due to a better understanding of the natural history of these di...

Research paper thumbnail of Ethical Cultures in Perinatal Care: Do They Exist? Correlation of Provider Attitudes with Periviability Practices at Six Centers

American Journal of Perinatology

Objective This study aimed to compare attitudes of providers regarding perinatal management and o... more Objective This study aimed to compare attitudes of providers regarding perinatal management and outcomes for periviable newborns of caregivers at centers with higher resuscitation (HR) and lower resuscitation (LR) rates in the delivery room. Study Design All obstetric and neonatal clinical providers at six U.S. sites were invited to complete an anonymous online survey. Survey responses were compared with clinical data collected from a previous retrospective study comparing centers' rates of planned resuscitation. Responses were analyzed by multivariable logistic and linear regression to assess how HR versus LR center respondents differed in management preferences and outcome predictions. Results Paradoxically, HR versus LR respondents, when adjusting for other variables, were less likely to respond that interventions such as antenatal steroids (odds ratio: 0.61, 95% confidence interval [CI]: 0.42–0.88, p

Research paper thumbnail of The Prediction and Cost of Futility in the NICU

Acta Paediatrica, 2012

Aim-To quantify the cost and prediction of futile care in the Neonatal Intensive Care Unit (NICU)... more Aim-To quantify the cost and prediction of futile care in the Neonatal Intensive Care Unit (NICU). Methods-We observed 1813 infants on 100 000 NICU bed days between 1999 and 2008 at the University of Chicago. We determined costs and assessed predictions of futility for each day the infant required mechanical ventilation. Results-Only 6% of NICU expenses were spent on nonsurvivors, and in this sense, they were futile. If only money spent after predictions of death is considered, futile expenses fell to 4.5%. NICU care was preferentially directed to survivors for even the smallest infants, at the highest risk to die. Over 75% of ventilated NICU infants were correctly predicted to survive on every day of ventilation by every caretaker. However, predictions of 'die before discharge' were wrong more than one time in three. Attendings and neonatology fellows tended to be optimistic, while nurses and neonatal nurse practitioners tended to be pessimistic. Conclusions-Criticisms of the expense of NICU care find little support in these data. Rather, NICU care is remarkably well targeted to patients who will survive, particularly when contrasted with care in adult ICUs. We continue to search for better prognostic tools for individual infants.

Research paper thumbnail of Negative Studies and the Future of Prenatal Counseling at the Margin of Gestational Viability

The Journal of Pediatrics

Research paper thumbnail of When Do Pediatricians Call the Ethics Consultation Service? Impact of Clinical Experience and Formal Ethics Training

AJOB Empirical Bioethics, 2020

Background: Previous research shows that pediatricians inconsistently utilize the ethics consulta... more Background: Previous research shows that pediatricians inconsistently utilize the ethics consultation service (ECS). Methods: Pediatricians in two suburban, Midwestern academic hospitals were asked to reflect on their ethics training and utilization of ECS via an anonymous, electronic survey distributed in 2017 and 2018, and analyzed in 2018. Participants reported their clinical experience, exposure to formal and informal ethics training, use of formal and informal ethics consultations, and potential barriers to formal consultation. Results: Less experienced pediatricians were more likely to utilize formal ethics consultation and more likely to have formal ethics training. The most commonly reported reasons not to pursue formal ECS consultation were inconvenience and self-reported expertise in pediatric ethics. Conclusions: These results inform ongoing discussions about ethics consultation among pediatricians and the role of formal ethics training in both undergraduate and graduate medical education.

Research paper thumbnail of International variations in application of the best-interest standard across the age spectrum

Journal of Perinatology, 2016

Objective: Ethically and legally, assertions that resuscitation is in a patient's best interest s... more Objective: Ethically and legally, assertions that resuscitation is in a patient's best interest should be inversely correlated with willingness to forego intensive care (and accept comfort care) at the surrogate's request. Previous single country studies have demonstrated a relative devaluation of neonates when compared with other critically ill patients.

Research paper thumbnail of Who tells a mother her baby has died? Communication and staff presence during stillbirth delivery and early infant death

Journal of Perinatology, 2017

Perinatal loss (stillbirth or early infant death) is often a sudden, unexpected event for familie... more Perinatal loss (stillbirth or early infant death) is often a sudden, unexpected event for families. We evaluated who communicates the loss to the parents and who is there for support at the delivery or death. STUDY DESIGN: We conducted a mail survey of 900 bereaved and 500 live-birth mothers to assess emotional, physical and reproductive health outcomes. RESULTS: We had a 44% response rate at 9 months after birth or loss from 377 bereaved mothers and 232 with surviving infants. Bereaved women were less likely to have hospital staff or family members present at delivery. African-American (versus Caucasian) mothers were half as likely to have first heard about their stillbirth from a physician or midwife. CONCLUSION: This is the first large study documenting who communicates perinatal death to families and who is present for support. Hospitals should be aware that many bereaved families may lack support at critical times.

Research paper thumbnail of Contemporary and diverse approaches to perinatal ethics

Seminars in Fetal and Neonatal Medicine

Research paper thumbnail of Consultative Service Utilization Around Periviable Deliveries

Pediatrics, 2019

INTRODUCTION Multiple factors play important roles in decision-making regarding delivery room res... more INTRODUCTION Multiple factors play important roles in decision-making regarding delivery room resuscitation in periviable infants. Studies have shown that practice variability exists between neonatologists and maternal fetal medicine specialists with respect to how periviable antenatal consultations are conducted. However, there is no data to date reporting utilization of other consultative services, or provider billing practices around periviable deliveries. METHODS: Inborn periviable births in 2013-2015 at 6 centers were reviewed retrospectively. Mothers/babies admitted with living fetuses for unplanned periviable delivery and born at 22 0/7 to 24 6/7 weeks gestational …

Research paper thumbnail of Parent Preferences for Neonatal Intensive Care Unit Physician Attire: A Cross-Sectional Study

American journal of perinatology, 2021

OBJECTIVE Physician attire may influence the parent-provider relationship. Previous studies in a... more OBJECTIVE Physician attire may influence the parent-provider relationship. Previous studies in adult and outpatient pediatrics showed that formal attire with a white coat was preferred. We aimed to describe parent preferences for physician attire in the neonatal intensive care unit (NICU). STUDY DESIGN We surveyed 101 parents in a level IV NICU. The survey included photographs of a physician in seven different attires. Attire was scored in five domains and parents selected the most preferred attire in different contexts. All attires were compared with formal attire with white coat. Descriptive statistics, Fisher's exact tests, and one-way analysis of variance were used to compare parent responses. RESULTS Scrubs without white coat (40.8 [7.0]) and formal attire without white coat (39.7 [8.0]) had the highest mean (standard deviation) composite preference scores. However, no significant differences between formal attire with white coat (37.1 [9.0]) versus any other attire were...

Research paper thumbnail of Prognostic Value of Clinicians' Predictions of Neonatal Outcomes in Counseling at the Margin of Gestational Viability

Seminars in Perinatology

Within antenatal counseling sessions at the margin of gestational viability, clinicians frequentl... more Within antenatal counseling sessions at the margin of gestational viability, clinicians frequently to use population-based outcome data and statistical models to guide the decision-making process. These tools often utilize non-modifiable prenatal factors to estimate outcomes based on population averages. However, most parents prefer individualized predictions, which cannot be supported by these models. Additionally, prognostic accuracy is limited by institutional practices surrounding active management of infants at the margin of viability. Throughout the literature, parental perspectives emphasize the importance of communicating subjective information, such as providing hope and supporting personal values, over the importance of accurate prognostic information from the clinician. In this review we aim to describe the value of clinician prognoses in the decision-making process at the margin of gestational viability and emphasize the importance of addressing parental values during the counseling process, regardless of the expected outcome.

Research paper thumbnail of Perinatal Counseling at the Margin of Gestational Viability: Where We’ve Been, Where We’re Going, and How to Navigate a Path Forward

The Journal of Pediatrics

Research paper thumbnail of Hospital Visitation Policies During the SARS-CoV-2 Pandemic

American Journal of Infection Control

A significant change for patients and families during SARs-CoV-2 has been the restriction of visi... more A significant change for patients and families during SARs-CoV-2 has been the restriction of visitors for hospitalized patients. We analyzed SARs-CoV-2 hospital visitation policies and found widespread variation in both development and content. This variation has the potential to engender inequity in access. We propose guidance for hospital visitation policies for this pandemic to protect, respect, and support patients, visitors, clinicians, and communities.

Research paper thumbnail of The impact of the COVID-19 pandemic on children with autism spectrum disorders

Journal of Pediatric Rehabilitation Medicine

In the unprecedented disruption and social isolation of the COVID-19 pandemic, families around th... more In the unprecedented disruption and social isolation of the COVID-19 pandemic, families around the world are faced with questions of how their children can thrive in these conditions. On top of the ubiquitous challenges for all children, this public health crisis imparts unique difficulties for children with special health needs. We identify children with Autism Spectrum Disorder (ASD) as being particularly vulnerable to negative impacts of the COVID-19 pandemic. In this paper, we examine why children with ASD are uniquely vulnerable, recommend strategies to mitigate these stressors for children with ASD and their parents, explore the potential challenges of reintegration into society as conditions improve, and examine the obligations of healthcare and community stakeholders to support these families.

Research paper thumbnail of Visitor Guidelines in US Children’s Hospitals During COVID-19

Hospital Pediatrics

OBJECTIVES: To examine visitor guidelines among children’s hospitals in the United States in resp... more OBJECTIVES: To examine visitor guidelines among children’s hospitals in the United States in response to the coronavirus 2019 (COVID-19) pandemic. METHODS: A retrospective assessment of visitor guidelines in 239 children’s hospitals in the United States. RESULTS: In this study, we present an analysis of 239 children’s hospital visitor guidelines posted to hospitals’ Web sites during 1 week in June 2020. Of the 239 hospitals, only 28 did not have posted guidelines for review. The guidelines were analyzed and grouped by how the guidelines were updated in response to COVID-19. Parental visitation was restricted to 1 parent in 116 of the posted guidelines (49%). There were no obvious similarities among guidelines associated with their geographical (eg, state or local) location. As of February 2021, 33 of 55 (60%) randomly selected hospitals had not changed their visitor policy since our initial review. CONCLUSIONS: The COVID-19 pandemic triggered changes in publicly reported visitor gui...

Research paper thumbnail of The Ethics of Creating a Resource Allocation Strategy During the COVID-19 Pandemic

Pediatrics

The coronavirus disease 2019 pandemic has affected nearly every aspect of medicine and raises num... more The coronavirus disease 2019 pandemic has affected nearly every aspect of medicine and raises numerous moral dilemmas for clinicians. Foremost of these quandaries is how to delineate and implement crisis standards of care and, specifically, how to consider how health care resources should be distributed in times of shortage. We review basic principles of disaster planning and resource stewardship with ethical relevance for this and future public health crises, explore the role of illness severity scoring systems and their limitations and potential contribution to health disparities, and consider the role for exceptionally resource-intensive interventions. We also review the philosophical and practical underpinnings of crisis standards of care and describe historical approaches to scarce resource allocation to offer analysis and guidance for pediatric clinicians. Particular attention is given to the impact on children of this endeavor. Although few children have required hospitalizat...

Research paper thumbnail of Flattening the Rationing Curve: The Need for Explicit Guidelines for Implicit Rationing during the COVID-19 Pandemic

The American Journal of Bioethics

Patients, the public, and especially the health professionals potentially confronting painful tri... more Patients, the public, and especially the health professionals potentially confronting painful triage decisions deserve to know whether these decisions are, in fact, "saving the most lives."

Research paper thumbnail of Should Extremely Premature Babies Get Ventilators During the COVID-19 Crisis?

The American Journal of Bioethics

In a crisis, societal needs take precedence over a patient's best interests. Triage guidelines, h... more In a crisis, societal needs take precedence over a patient's best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. But surviving babies will likely live longer, maximizing lifeyears. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When "triaging" or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies.

Research paper thumbnail of Shifting Provider Attitudes and Institutional Resources Surrounding Resuscitation at the Limit of Gestational Viability

American Journal of Perinatology

Objective This study aimed to provide contemporary data regarding provider perceptions of appropr... more Objective This study aimed to provide contemporary data regarding provider perceptions of appropriate care for resuscitation and stabilization of periviable infants and institutional resources available to providers. Study Design A Qualtrics survey was emailed to 672 practicing neonatologists in the United States by use of public databases. Participants were asked about appropriate delivery room care for infants born at 22 to 26 weeks gestational age, factors affecting decision-making, and resources utilized regarding resuscitation. Descriptive statistics were used to analyze the dataset. Results In total, 180 responses were received, and 173 responses analyzed. Regarding preferred course of care based on gestational age, the proportion of respondents endorsing full resuscitation decreased with decreasing gestational age (25 weeks = 99%, 24 = 64%, 23 = 16%, and 22 = 4%). Deference to parental wishes correspondingly increased with decreasing gestational age (25 weeks = 1%, 24 = 35%, ...

Research paper thumbnail of Professional Obligations of Clinicians and Institutions in Pediatric Care Settings during a Public Health Crisis: A Review

The Journal of Pediatrics

Research paper thumbnail of Ethical decision-making for children with neuromuscular disorders in the COVID-19 crisis

Neurology

The sudden appearance and proliferation of COVID-19 has forced societies and governmental authori... more The sudden appearance and proliferation of COVID-19 has forced societies and governmental authorities across the world to confront the possibility of resource constraints when critical care facilities are overwhelmed by the sheer numbers of grievously ill patients. As governments and health care systems develop and update policies and guidelines regarding the allocation of resources, patients and families affected by chronic disabilities, including many neuromuscular disorders that affect children and young adults, have become alarmed at the possibility that they may be determined to have less favorable prognoses due to their underlying diagnoses and thus be assigned to lower priority groups. It is important for health care workers, policymakers, and government officials to be aware that the long term prognoses for children and young adults with neuromuscular disorders are often more promising than previously believed, due to a better understanding of the natural history of these di...

Research paper thumbnail of Ethical Cultures in Perinatal Care: Do They Exist? Correlation of Provider Attitudes with Periviability Practices at Six Centers

American Journal of Perinatology

Objective This study aimed to compare attitudes of providers regarding perinatal management and o... more Objective This study aimed to compare attitudes of providers regarding perinatal management and outcomes for periviable newborns of caregivers at centers with higher resuscitation (HR) and lower resuscitation (LR) rates in the delivery room. Study Design All obstetric and neonatal clinical providers at six U.S. sites were invited to complete an anonymous online survey. Survey responses were compared with clinical data collected from a previous retrospective study comparing centers' rates of planned resuscitation. Responses were analyzed by multivariable logistic and linear regression to assess how HR versus LR center respondents differed in management preferences and outcome predictions. Results Paradoxically, HR versus LR respondents, when adjusting for other variables, were less likely to respond that interventions such as antenatal steroids (odds ratio: 0.61, 95% confidence interval [CI]: 0.42–0.88, p