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 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
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 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
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
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. -
Виктория Антонова
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. -
Виктория Антонова
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 -
Виктория Антонова
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"