Recent discussions
-
Виктория Антонова
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. -
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
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 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
Wise perspective. -
Виктория Антонова
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. -
Виктория Антонова
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. -
Виктория Антонова
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. -
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. -
Виктория Антонова
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