Family Presence During Resuscitation CoSTR (PLS 384) ESR

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This Review is a draft version prepared by ILCOR, with the purpose to allow the public to comment and is labeled “Draft for Public Comment". The comments will be considered by ILCOR. The next version will be labelled “draft" to comply with copyright rules of journals. The final Review will be published on this website once a summary article has been published in a scientific Journal and labeled as “final”.

Family Presence During Pediatric Resuscitation

Conflict of Interest Declaration

The ILCOR Continuous Evidence Evaluation process is guided by a rigorous ILCOR Conflict of Interest policy. The following Task Force members and other authors were recused from the discussion as they declared a conflict of interest: None

The following Task Force members and other authors declared an intellectual conflict of interest and this was acknowledged and managed by the Task Force Chairs and Conflict of Interest committees: None

CoSTR Citation

Wyllie JP, Wyckoff MH, de Almeida MF, Aziz K, El-Naggar W, Fabres JG, Fawke J, Foglia EE, Guinsburg R, Hosono S, Isayama T, Kawakami B, Kapadia VS, Kim HS, Liley HG, McKinlay CJD, Perlman JM, Rabi Y, Roehr CC, Schmölzer GM, Sugiura T, Trevisanuto D, Weiner GM and Dainty KN. Family Presence During Neonatal Resuscitation. International Liaison Committee on Resuscitation (ILCOR) Neonatal Life Support Task Force, Nov 2020. Available from: http://ilcor.org

Collaborators

The Pediatric Life Support Task Force of the International Liaison Committee on Resuscitation (ILCOR).

Methodological Preamble and Link to Published Systematic Review

The continuous evidence evaluation process for the production of Consensus on Science with Treatment Recommendations (CoSTR) started with a systematic review of family presence during pediatric resuscitation conducted by the Knowledge Synthesis Unit at St Michael’s Hospital, Toronto, Canada with involvement of clinical content experts {Dainty KN 2020 submitted}. Evidence for pediatric literature was sought and considered by the Pediatric and Neonatal Task Forces. These data were taken in account when formulating the treatment recommendations.

Systematic Review

Dainty KN, Atkins D, Breckwoldt J, Maconochie I, Schexnayder SM, Skrifvars MB, Tijssen J, Wyllie J, Furuta M. for the International Liaison Committee on Resuscitation’s (ILCOR) Pediatric and Neonatal Life Support Task Forces. Effect of family presence during resuscitation in pediatric cardiac arrest on patient, parent and health care provider outcomes: A systematic review {Dainty KN 2020 submitted}

PICOST

Population: In neonates requiring resuscitation in any setting

Intervention: Does family presence during resuscitation

Comparators: Compared to no family presence during resuscitation

Outcomes: Result in improved patient outcomes (short and long term), family-centered outcomes (short and long term, perception of the resuscitation), and health care provider-centered outcomes (perception of the resuscitation, psychological stress)

Study Designs: Randomized controlled trials (RCTs) and non-randomized studies (non-randomized controlled trials, interrupted time series, controlled before-and-after studies, cohort studies, qualitative) are eligible for inclusion. Unpublished studies (e.g., conference abstracts, trial protocols) are excluded.

Timeframe: All years and all languages are included as long as there is an English abstract

PROSPERO Registration CRD42020140363

Data Analysis

The definition and approach to “family presence” during resuscitation was highly variable leading to great heterogeneity in the types of published studies available on this topic. The majority of the articles were observational in nature, and most collected data via surveys or using qualitative interview techniques. These articles provided low or very low-quality evidence and did not provide data which can be meta-analyzed to compare outcomes (i.e., by family presence vs. no family presence). However, the team considered that there was important knowledge to be synthesized from the research, and for this reason, a narrative review was performed.

The overall certainty of evidence was rated as very low for all outcomes. A formal assessment of risk of bias was not conducted but the studies were considered as being at high risk of bias due to selection bias. The totality of the evidence must also be considered as characterised by serious indirectness; many of the surveyed participants had not themselves participated in a resuscitation with presence of family members and in addition, healthcare providers were not necessarily analysed separately from parents or professional group. Within the studies, methods to assess risk of bias were not reported. Furthermore, the study-specific surveys were each used for one study only and were not published or validated. The total number of participants was small, and only a narrow range of socio-cultural settings was represented.

Only one study to date (July 2020) reported data on demographic patient-level resuscitation interventions and Apgar scores for family presence during neonatal resuscitation but this was demographic rather than outcome data. For family-centred outcomes (experience, perception of the resuscitation), and health care provider-centred outcomes (perception of the resuscitation, psychological stress, effect on workload) only qualitative and survey method studies (n=37) were identified, which each used a different instrument and therefore were unsuitable for a meta-analysis.

The literature on family presence during neonatal resuscitation includes eight studies, six of which were qualitative {Arnold, 2012, e002487, Harvey 2012 F439, Harvey 2013 e002547, Lindberg 2007 142, Sawyer 2015 e008495, Yoxall 2015 e008494} ,with the other two studies using survey methodology {Katheria 2018 100, Zehnder 2020 F1}.

Three of the qualitative studies focused on the experience of fathers during their baby’s resuscitation {Harvey 2012 F439, Harvey 2013 e002547, Lindberg 2007 142}, two focused on the experience of both parents {Arnold, 2012, e002487, Sawyer 2015 e008495} and one looked at provider opinion {Yoxall 2015 e008494}. One of the survey studies included both parent and provider opinions {Katheria 2018 100} and the second used the National Aeronautics and Space Administration Task Load Index (TLX) {Zehnder 2020 F1} to assess workload amongst health care providers (performance, effort, frustration, mental, physical and temporal demand). It is of note that all studies were from high resource settings and a small number of countries (UK, USA and Canada).

Consensus on Science

  • For the critical outcome of improved patient outcomes (short and long term) there were no useful data to inform practice. Only one study reported Apgar scores in demographic data {Zehnder 2020 F1}.
  • For the important outcome of family centered outcomes there were 7 studies reporting on 144 people, all from high resource settings. The studies included 4 surveys of parents or family members who were present during stabilization or resuscitation (Arnold 2012 e002487, Harvey 2012 F439, Lindberg 2007 142, Sawyer 2015 e008495}, 2 surveying the opinions of health care providers {Harvey 2013 e002547, Yoxall 2015 e008484} and 1 surveying both health care providers and parents {Katheria 2018 100}. Overall, the findings in these mainly qualitative studies reflected a positive experience for families who were present during the stabilization or resuscitation of their newborn babies. Qualitative themes included:
    1. The unique experience and perspective of fathers/partners particularly around their knowledge of what happened.
  • Fathers/partners focused on their partner at the time of the resuscitation/stabilisation event.
  • Parents felt that being present provided reassurance and opportunities for involvement and communication, but parents also reported some reservations about the emotional toll of witnessing a resuscitation.
  • The need for staff training in support and debriefing of parents.
  • Parental presence at birth was characterised by intense but polarized emotions ranging from desperation to see the baby immediately, to fear of witnessing a situation involving their baby they would rather have avoided.
  • For the important outcome of health care provider outcomes, we identified 4 studies. Two of the papers surveyed opinions of health care providers who had participated in a resuscitation with family presence or delivery of the baby with all immediate care beside the mother for delayed clamping of the umbilical cord {Harvey 2013 27, Yoxall 2015 e009484}. One paper surveyed parental opinion (Sawyer 2015 e008495). One paper surveyed health care providers and found that the presence of a family member reduced perceived workload {Zehnder 2020 F1}.

Overall, health care provider participants were professionals who were used to having parents in attendance and did not report any major detrimental effects. However, some expressed concern that less experienced professionals may feel under increased pressure while being observed {Harvey 2013 27, Yoxall 2015 e008494}. This finding was not reported in the one study assessing workload {Zehnder 2020 F1}. The potential impact on staff performance was also raised as a concern by parents in one study {Sawyer 2015 e008495}.

Treatment Recommendations

We suggest it is reasonable for mothers/fathers/partners to be present during the resuscitation of neonates where circumstances, facilities and parental inclination allow. This is a weak recommendation based on very low certainty of evidence.

There is insufficient evidence to indicate an interventional effect on patient or family outcome. Being present during the resuscitation of their baby seems to be a positive experience for some parents but concerns about an adverse effect upon performance exist among both healthcare providers and family members.

Justification and Evidence to Decision Framework Highlights

In making these recommendations, the Neonatal Life Support Task Force considered the following:

  • Whilst family presence during neonatal resuscitation is practiced in some settings, it has never undergone systematic review and practice varies internationally. During the COVID-19 pandemic some services have moved neonatal resuscitation sites to locations separated from parents making this question a priority for the Neonatal Life Support Task Force.
  • All the included papers originate in the UK, USA or Canada.
  • All the included papers related to resuscitation at birth.
  • Mothers are always present at birth and it seems that most healthcare providers surveyed in included publications feel partner/support person presence should be offered but with the caveat that facilitation and support of the families requires sufficient numbers and training of personnel.
  • Of note, we did not identify any eligible randomized controlled trials or large cohort studies comparing family presence to no family presence during neonatal resuscitation. We acknowledge the lack of clinical trial data for this topic in our knowledge gaps.
  • It is notable that the evidence came from the opinions of only 144 parents and 350 health care providers in total, all sampled in tertiary centres in the UK, USA or Canada.

Knowledge Gaps

There were no studies identified that provided adequate comparative data to address this PICO question in the setting of a neonate receiving resuscitation at birth or within the first month of life. The majority of published work used retrospective survey or qualitative methods and included births where resuscitation was not required. There would be serious ethical constraints on performing a randomized controlled trial to address this question, among which would be the extreme difficulty of obtaining informed consent. Therefore, larger scale observational studies with appropriate quantitative and qualitative outcome and experience measures are recommended. In addition to addressing parent and health care provider-centered outcomes, studies are needed to address whether or not family presence affects the outcome of a resuscitation and whether family presence impacts decisions to continue or discontinue resuscitation.

The included studies all came from delivery rooms studied in high resource settings. Subsequent studies are needed that recruit from different socioeconomic, cultural and organizational settings.

Attachments

Evidence-to-Decision Table for Family Presence During Resuscitation

References

Arnold L. Sawyer S, Rabe H, Abbott J, Gyte G, Duley L, Ayers S, Parent’s first moments with their very preterm babies: a qualitative study. BMJ Open 2013;3: e002487

Dainty KN, Atkins D, Breckwoldt J, Maconochie I, Schexnayder SM, Skrifvars MB, Tijssen J, Wyllie J, Furuta M Effect of family presence during resuscitation in paediatric cardiac arrest on patient, parent and health care provider outcomes: A systematic review. submitted

Harvey ME, Pattison HM. Being there: a qualitative interview study with fathers present during the resuscitation of their baby at delivery. Archives of Disease in Childhood-Fetal and Neonatal Edition. 2012 Nov 1;97(6):F439-43.

Harvey ME, Pattison HM. The impact of a father's presence during newborn resuscitation: a qualitative interview study with healthcare professionals. BMJ open. 2013 Jan 1;3(3):e002547.

Katheria AC, Sorkhi SR, Hassen K, Faksh A, Ghorishi Z, Poeltler D. Acceptability of bedside resuscitation with intact umbilical cord to clinicians and patients’ families in the united states. Frontiers in pediatrics. 2018 Apr 26;6:100.

Lindberg B, Axelsson K, Ohrling K. The birth of premature infants: Experiences from the fathers’ perspective. Journal of Neonatal Nursing. 2007; 13(4):142-149

Sawyer A, Ayers S, Bertullies S, Thomas M, Weeks AD, Yoxall CW, Duley L. Providing immediate neonatal care and resuscitation at birth beside the mother: parents’ views, a qualitative study. BMJ open. 2015 Sep 1;5(9):e008495.

Yoxall CW, Ayers S, Sawyer A, Bertullies S, Thomas M, Weeks AD, Duley L. Providing immediate neonatal care and resuscitation at birth beside the mother: clinicians’ views, a qualitative study. BMJ open. 2015 Sep 1;5(9):e008494.

Zehnder E, Law BHY, Schmölzer GM. Does parental presence affect workload during neonatal resuscitation? Arch Dis Child Fetal Neonatal Ed 2020;0:F1–F3. doi:10.1136/archdischild-2020-318840


Systematic Review, Family Presence

Discussion

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Federico Zaglia (360 posts)
Agree. Good job indeed.
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Kitty Bach (360 posts)
Important to add. I agree with the balance struck given the low quality of evidence; however, embracing this is important in order to start thinking about advancements in this area of research.
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Trevor Cresp (360 posts)
As a health professional, Its a difficult situation, but where a newborn was 'not expected' to have problems and to see the team working to support the newborn through that event good or bad perhaps allows for the 'grieving' process to begin. Where's an 'expected' event Medical Emergency and newborn is taken away for support can be a difficult process for families - mother etc... We are always learning and hence why training -SIMS etc.. put us in a situation where mother, family is present. Thanks
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Jacqueline Greenidge-Payne (360 posts)
I feel that the parents should be there in a resuscitation efforts, it help them to bring closure, with them seeing all the efforts given to saving their childs life. Being a EMS provider to 30 year at time parents feel that more could have been done , but seeing it gets to there affective domain
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Jonathan Wyllie (360 posts)
Thank you. I don't disagree at all with the comments made here but we had to look at what the evidence supported. It was surprising how little data was available.
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Virginia Lira (360 posts)
I agree with the task based in Personal experience because It is a difficult situation all profissionals have to take care. When the family participate They understand the procedures and the staff efforts
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Luiz Henrique Gamba (360 posts)
I agree
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Maria Clara Alves Moreira (360 posts)
I believe that parents should be present in the delivery room, despite being a difficult situation for both the family and the doctor. However, the focus of attention is on the patient and his family. I think it should be part of medical training to know how to act in stressful situations, without disrupting our performance. Furthermore, I believe It's important that the family sees that all the efforts were made to save the child.
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Scheila Siebeneicher (360 posts)
For 20 years, we have had a policy of resuscitation in the delivery room without removing the parents. The newborn is seen in the same delivery room, and the presence of the companion is always encouraged. Personally I think it is much easier for the doctor to explain to the family what happened when they saw the care. And the family seems to be more comfortable when they are allowed to stay in the room than if the service is "hidden" from them. I have been in the delivery room for many years and I only see benefits in the family staying in the resuscitation room.
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Maria Bouzada (360 posts)
I think we'd have to ask parents/partners in advance if they want to be there. Which won't always be possible. But, humans have individual reactions that are often related to their personal difficulties, beliefs and cultural patterns Even if studies with large populations were conducted, there would be many variables to be considered which might be a limiter to indicate the results to all.
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Brady Kerr (360 posts)
Wise perspective.
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Gislayne Nieto (360 posts)
It's very important to think about this topic. It is a difficult decision for the health professional to allow the family at the time of neonatal resuscitation. If the father or mother wishes to be present at this difficult time, the team must be prepared for this situation and must train even more communication and host techniques Thank you
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Angélica Carvalho (360 posts)
In my country it is not likely to have parents inside resuscitation room, even before Covid 19. I suppose that parents’ presence could help to deal with suffering and sadness in case of newborn’s death. It should improve confidence in the hospital team’s work after resuscitation and baby goes to intensive care unit. In Brazil, I think we need training and many efforts to bring this practice as a reality in most of hospitals.
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Sérgio Marba (360 posts)
I agree that parents participate in neonatal resuscitation as a way to monitor and find out if everything is correct in their children's neonatal care, even without robust evidence in the literature.
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José Roberto Ramos (360 posts)
this is a very interesting and important topic. although there is no solid evidence I think that family-centered outcomes about perception of the resuscitation and about health care provider-centered outcomes sobre perception of the resuscitation and psychological stress could be relevant
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José Roberto Ramos (360 posts)
We received the following text: "this is a very interesting and important topic. although there is no solid evidence I think that family-centered outcomes about perception of the resuscitation and about health care provider-centered outcomes about perception of the resuscitation and psychological stress could be relevant"
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Racire Silva (360 posts)
It was a very good initiative to study about the presence of parents in resuscitation. It seems that we medical professionals, especially neonatologists, have some difficulties in recognizing that parents have a fundamental role in the care of that patient who is ours for a few moments. Before the pandemic we always had companions in delivery rooms, now they are very low. In Brazil, where I live, we still have many difficulties in which parents, due to their low knowledge of what is happening with the child, may misinterpret some procedures, being essential the presence of someone from the team to clarify them.
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Racire Silva (360 posts)
It was a very good initiative to study about the presence of parents in resuscitation. It seems that we medical professionals, especially neonatologists, have some difficulties in recognizing that parents have a fundamental role in the care of that patient who is ours for a few moments. Before the pandemic we always had companions in delivery rooms, now they are very low. In Brazil, where I live, we still have many difficulties in which parents, due to their low knowledge of what is happening with the child, may misinterpret some procedures, being essential the presence of someone from the team to clarify them.
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Dharmendra Nimavat (360 posts)
It's a double edge sword. It's always an excellent idea to allow family members to be present during newborn resuscitation. What happens when no one could be there for any reason? Resuscitation could come under suspicion that no one was there so we don't know how and what happened? When make a generalized policy statement one should be very careful and consider it's ramifications as well.
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Barry Perlin (360 posts)
Are you kidding? It’s hard enough for communication to the Staff during a resuscitation without worrying about what, when and how you say it!! Next the family will want to record and/or video tape the proceedings to show to the public, including their lawyers if things don’t turn out well....Most nurses over the years have told me they were glad when family was excluded from presence during even a procedure as ‘benign’ as starting an IV. After being on the ground, in the DR for over 40 years, DON’T DO IT! Not to mention Covid-19...
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Barry Perlin (360 posts)
Don’t do it——Staff communication can be recorded and/or videotaped, and I have heard of Neo and, on a separate occasion, the OB facing ridiculous malpractice charges....Family doesn’t understand what would be going on during resuscitation and what is the purpose? Does the Committee really think we need them in the DR/NICU to see how hard we try to save their baby?.... After over 40 years on the front lines in the DR/NICU doing these resuscitations, I cannot imagine conducting a code without at least one swear word.... Nurses have thanked me over the years for excluding family during procedures, such as IV starts... I recommend that committee not make a recommendation that will make it even more difficult for professionals to do our job to save the babies—- Ask the surgeons if they would make it a policy to let family into the OR......
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Jonathan Wyllie (360 posts)
Thank you for your balancing input and views. The review was based on the evidence available and takes into account that in many areas of the world (such as my own) it has been standard practice for parents to be present. Similarly there are areas of the world where either for cultural reasons or your own perceptions this is not the case. We were therefore trying to find out exactly what the evidence was. As it transpires, despite very polarised views, there is little hard evidence to support any particular approach. This means we require more evidence for future reviews. We hope that this point was clearly made? Thank you again to everyone taking time to comment.
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Kimberly Lee (360 posts)
As a neonatologist I appreciate the careful review. Conclusions make sense given available evidence. (More support for individualized care for babies/families in difficult situations -- as challenging as it is for us as physicians/care teams!)
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Jonathan Wyllie (360 posts)
Thank you everyone who has commented so far. These are all helpful comments and perspectives to assist in the final wording of the CoSTR
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Nicole Udsen Luis (360 posts)
I beleive that the presence of parents in the delivery room can help with the understanding of the severity of the illness as well as with the efforts undertaken in the care of the patient. But at times family agression or desperation can be a difficult situation for the care providers to deal with. Ideally there should be training among staff to help deal with the situation, as well as a person on the team that can help with explanations for the family.
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Laurie Warnock (360 posts)
See ‘Health Care Providers’ Attitudes Regarding Family Presence During Resuscitation of Adults An Integrated Review of the Literature’ MARY SUSAN L. HOWLETT, BSN, RN, CEN; GAIL A. ALEXANDER, BSN, RN, CCRN; BRENDA TSUCHIYA, MSN, RN, NP-C
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Jonathan Wyllie (360 posts)
Thank you. This was a neonatal subset of a wider paediatric review. This article was not included in the paediatric review because it focused on adult resuscitation but does indeed include interesting perspectives.
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Denise Suguitani (360 posts)
I agree that the presence and participation of parents in all times of babies journey is essential, even in critical situations such as resuscitation (contribution from Brazil).
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Debs Massey (360 posts)
Parents attending resuscitation reflect back that they knew 'everything was done' and seem to be more comforted, even though it's hard to watch. We have one member of staff updating the parents which is of course easier for us in a tertiary centre. I always invite parents to witness, if they refuse that is their choice. - ANNP.
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Mary Pylipow (360 posts)
I agree with the supportive comments and have always allowed family to be present. It is most helpful to have one trained staff person who can stay with the parent, supporting & calmly but briefly explaining what is happening. If parent’s emotional reaction is distracting to the team, they can step out of the room with that staff person. Filming by the family is discouraged / not allowed but if it occurs, is from a distance.
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Brady Kerr (360 posts)
This is a fascinating topic with many aspects to thoughtfully consider before making any recommendations. First, the available data/studies seem to be quite lacking to make any truly informed recommendations. So without a doubt, this should be studied prior to implementation. From a practical standpoint, there may be other similar medical situations to review that may enlighten your decision. For example, are there data from adults ICUs, ED codes, or PICU codes to draw from? Also, are we only discussing initial resuscitation at birth, or code situations within the NICU for established and already admitted patients? For many deliveries, the team resuscitating the infant may have never met any family members prior to an emergent resuscitation at birth. This is in stark contrast to an established patient in the NICU, who may have been hospitalized for several weeks - for which the caregiver team and the parents may have a well established rapport. In general, having an observer of any process can influence the process itself. The classic example is with hand-washing. Having a parent in the delivery room does promote family-centered care and may enhance the likelihood the team performing the resuscitation will adhere to the NRP algorithm. On the other hand, in a high risk environment it would seem logical to control those variables that can be controlled. Distractions can potentially cause anxiety among the team performing the resuscitation, decreasing the quality of the resuscitation and the eventual outcome of the resuscitation - even when the process or NRP algorithm is well known and the team is capable and experienced at neonatal resuscitation. Even veteran professional basketball players can have difficulty making a free throw under intense pressure. Another consideration is the local culture and belief systems of the region. What is acceptable in Japan or India maybe quite different than in another country. There are also the legal ramifications to ponder. In general, we should strive to have parents highly involved with all aspects of care for neonatal patients. However, in our strive to promote family centered care, we must not sacrifice quality or safety for the primary patient. We are often compared to the airline industry when it comes to quality and safety. As a airline passenger, I am not allowed into the cockpit/flight deck while the pilot is performing his or her duties during the flight, especially not when he or she is navigating a storm or taking off/landing (the high pressure times during which the consequences of errors are the greatest). There is also the question of how families will deal with the information they are observing - both intellectually and emotionally. While some parents may be well equipped to witness CPR on their baby, others may be traumatized by the experience. Overall, I think there is a role and place for families to be present during resuscitation. We just have to think critically and review the evidence (or study this topic more) prior to making it a universal or widely recommended policy.
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Anna Sedney (360 posts)
Limited evidence in neonates but plenty of studies in older children and adults - policy should include importance of an assigned role of family liaison. There are data to support a structured debrief for the medical team whether successful resuscitation or not.
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Nathalie Thurler (360 posts)
Despite the still weak evidence, I believe that the presence of parents will provide better understanding of the situation, leaving them close to reality. In this way, see what is being done by the baby especially in the most difficult outcome situations. I believe that communication will be a very important factor for maintaining this practice, as parents are close and aware of the procedures.
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Ashley Durham (360 posts)
I am a LDRP nurse and I am almost finished with my certified nurse midwife program. But most importantly I am a mother to two children who received NRP. I could not get up and be nearby while they received resuscitation because I was still in the middle of a cesarean section but my husband was not allowed to go back with them even though I requested he be able to. I Believe that parents should have the right to determine whether or not they want to witness and be involved in the resuscitation. Like every other situation they should be able to make the decision about what they feel is best for their family in that moment in time. One of my children has complex congenital heart defects that has required many hospitalizations including open heart surgery and ecmo. Thankfully we have not been put in a position where she has required any type of resuscitation outside of the OR but if we had been presented with that situation I would want to stay by her side and witness the resuscitation. That is important to me. Not all parents would feel the same But I feel that I have a right to make the decision For myself and my family
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MARY YADA (360 posts)
I very much agree on the importance of the presence of parents during neonatal resuscitation. It is a very complicated moment for professionals and painful for the family, but it is necessary to be together in the procedures and decisions for the best outcome.
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Mohamed Sewidan (360 posts)
I think this should be a variable option related to local standards and cultures of each health care setting in different countries. I believe some parents would not be able to tolerate stressful resuscitation experience to their sick newborn who needed a lot of interventions even the outcome came good. However, others will tolerate and even be grateful to the resuscitation team for their efforts. I think it should be individualized.
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Naveed Durrani (360 posts)
I think family needs to be defined, as sometimes husband not available, grandparents sometimes available only. Mother can’t see baby , lot of people around resuscitoir, also c sec vs delivery suite makes lot of difference for such arguments. Presence in room vs actual viewing of resuscitation?? Needs lot of clarification plus effect on team etc
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David Endress (360 posts)
I think that even though there (still) seems to be not enough hard evidence for familiy presence it is also our ethical duty to allow and even encourage family presence. After all it is imperative to build and strenghten patient/family autonomy!
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James Pergolizzi III MD (360 posts)
I thank everyone involved for their effort. I agree the evidence is so weak that perhaps no official recommendation should be made at this time. Given that the majority of neonatal resuscitations are immediately post birth at least one parent, the mother, is typically in the room unless the infant is removed to be resuscitated elsewhere. Given that the mother and often a support person are present, one focus should be on how much involvement they have in the resuscitation. The “parents “ are rarely more than 20 feet away and often the crib/ table is adjacent to the mother’s bed. Hence they are witness to the efforts being made to resuscitate their infant. The individual leading the resuscitation can clearly explain the steps being taken to improve the infants condition with comments such as “ we are placing a tube into your baby’s mouth to help her/ him breathe “, similarly for catheters, etc. If not someone at the infants side then another medical person in the room can relay the information. The process is 10-15 minutes after which the infant is taken over to the “parents” to show how he/ she was stabilized or to allow them to hold if the results were unfavorable. Effort should be directed toward how best to communicate during this brief period. Resuscitation in the nursery or NICU is a different set of circumstances and may be best discussed separately. I am a neonatologist covering both a level 3 facility and a community hospital simultaneously for 35 years in the US. Thank you.
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Sarah Nee (360 posts)
I think there is no way way to make a specific recommendation. It needs to almost be a case by case situation. Parents should always have a part in the care of their child. Sometimes though that part may interfere with people doing their job well. If we do a full resuscitation in the delivery room there is barely enough room for all the staff, also given what is happening you almost need a person to support and explain things to the parents, we usually will not have extra staff to do this if we have a full code going on.
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Jackeline Della Torre (360 posts)
I agree that parents should be presente during neonatal reanimating. Its’s a very difficult topic, but I believe being present and testifying all efforts to save the baby can help to understand the severity of the situation and may help the mourning process.
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Júlia Firmo (360 posts)
Agree
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Júlia Firmo (360 posts)
Totally agree! Parents should be there in that moment, it's so necessary as family and as profissional! Our kids need to know that we'll be there for them, and give us a fresh start seem that professionals given there best
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Giordana Motta (360 posts)
As a neonatal nurse and a mother who saw her baby being stabilized in a critical situation once, I believe the parents should have the choice to witness it or not. When a risk birth is expected and during baby's staying at the NICU, this issue should be discussed and the staff should know the parent's position when the situation arrives. About this piece of research, I would suggest for a future research the use of meta-synthesis to synthesize the qualitative evidence, considering the majority of the studies are qualitative in nature. A qualitative systematic review on the subject would give us more reliable information from the existing publications.
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Larissa Cavalcante (360 posts)
Primeiramente, parabéns pelo tópico! Válida a discussão. Bom, acredito que a presença dos pais em todos os momentos, desde o nascimento, sejam eles críticos ou não, é muito importante e essencial. No momento da reanimação, acredito que faz com que aumente a compreensão da situação, ela terminando ali ou não.
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Natacha Berbert (360 posts)
Eu acho que os pais nao deveriam presenciar esse momento. Ppis é algo muito angustiante, se o bebe vier a obto, os pais podem nao estar preparados. Brazil - sao paulo
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Bresolin Victor (360 posts)
Entendo que não há suporte emocional para o acompanhamento dos pais nesse momento tão nervoso.
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Lia Lopes (360 posts)
I agree. Brazil
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Pramod Mallipaddi (360 posts)
In my experience, Presence of parents almost always helped. Especially when the out come was bad.
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Juliana Medina (360 posts)
A presença dos pais é indispensável! É importante para o bebê sentir a presença, sentir-se seguro e amado. Acredito que os pais fortalecem os Filhos e os filhos são a força que os pais precisam
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Laisa Silva (360 posts)
I speak for myself. (Mother, premature 24 weeks) And I think that the presence of parents at that moment is not good and useful. The desire is to be present, but we have to know how to let the professionals do their job and trust. It is a delicate moment and their concern should be the baby's resuscitation. With the parents close, I think it would be distracting. My son's resuscitation at birth was done in the same room I was in, but I didn't see anything, everything was very fast. Apart from these delicate moments, I believe that the family must be very present in all procedures performed on the baby at Neo ( Portugal)
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Livia Tatoni Rocha de Souza (360 posts)
Whats the point about the parents presence? I think it is a moment that requires technical and rational actions, not a emotional interference. [from Brazil]
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Elaine Arima (360 posts)
I think that the recommendation should be that parents should always have a part in the care of their child, including the possibility to be present during ressucitation if they want to. Until there's negative evidence telling not to. I've had my baby ressucitated in my presence and, although I felt miserable by the time, now I can tell that it gave me more confidence in the health team and a direct/clear "dose of reality" about her situation. But as a psychologist that helps parents, I can tell that it can be extremily traumatic to some people. And the point here should be how to identify these traumatized people and take care of them rather than don't allow than to be with their child. I'm from Brazil!
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Gustavo Pelligra (360 posts)
Agree with the task force recommendations. Although challenging in certain settings, it’s important to have a team member designated to support and guide family members during the resuscitation, as well as resources to support them after. Thanks
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Zeynep Salih (360 posts)
This is a tough topic... Each situation, each family, each bedside team is different. However, if there is trust in the hospital and the healthcare team parents would mostly appreciate being in the room where CPR is performed. Thus, being flexible, excellent communication skills, anticipation and being prepared is critical. Interprofessional education is essential.
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Silvia Loffredo (360 posts)
I believe that to the family should be offered the opportunity to follow all the procedures of Neonatal Resuscitation. However , they have to be previously warned that complications can happen, regardless of the conditions of the newborn, pregnancy and child-birth.
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Isamu Hokuto (360 posts)
I agree that the family participate in neonatal resuscitation even in the serious condition. However, we must know how they feel after attending their child's resuscitation. Some parents or siblings might feel shocked and pain.
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