Recent discussions
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Виктория Антонова
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. -
Виктория Антонова
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 -
Виктория Антонова
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). -
Виктория Антонова
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! -
Виктория Антонова
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. -
Виктория Антонова
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. -
Виктория Антонова
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. -
Виктория Антонова
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. -
Виктория Антонова
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. -
Виктория Антонова
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.