Hemananda Muniraman1,2, Miranda Cascione3, Rangasamy Ramanathan1,2, Jimmy Nguyen1,2. 1. a Division of Neonatal-Perinatal Medicine, Department of Pediatrics, LAC + USC Medical Center, Keck School of Medicine , University of Southern California , Los Angeles , CA , USA. 2. b Center for Fetal and Neonatal Medicine, Division of Neonatal-Perinatal Medicine , Children's Hospital Los Angeles, University of Southern California , Los Angeles , CA , USA. 3. c UCLA School of Law , University California Los Angeles , Los Angeles , CA , USA.
Abstract
OBJECTIVE: The management of expectant mothers and infants born at the threshold of viability is challenging. We describe medicolegal cases from a major United States legal database involving periviable births in an effort to identify areas for improvement. STUDY DESIGN: We conducted a retrospective review of all United States state and federal cases in the Westlaw database from 1980 through 2016 involving peripartum and immediate post-delivery management of infants born between 22 0/7 and 25 6/7 weeks' gestation. RESULTS: Our search criteria returned 736 results, and 15 cases met full inclusion criteria. Eight cases involved conflicts on resuscitation contrary to parental directives. Eleven cases comprised alleged miscommunication between families and providers. Of these, seven cases alleged inadequate prenatal counseling of infant's chances of survival and neurological outcome, whilst four cases alleged miscommunication of infant's condition post-delivery. CONCLUSIONS: Miscommunication between providers and families during prenatal counseling and after birth was a major component of malpractice cases regarding infants born at the threshold of viability. The infant's immediate post-delivery condition and long term prognosis were of primary interest to parents, and improving effective communication may aid toward more genuinely informed resuscitation directives.
OBJECTIVE: The management of expectant mothers and infants born at the threshold of viability is challenging. We describe medicolegal cases from a major United States legal database involving periviable births in an effort to identify areas for improvement. STUDY DESIGN: We conducted a retrospective review of all United States state and federal cases in the Westlaw database from 1980 through 2016 involving peripartum and immediate post-delivery management of infants born between 22 0/7 and 25 6/7 weeks' gestation. RESULTS: Our search criteria returned 736 results, and 15 cases met full inclusion criteria. Eight cases involved conflicts on resuscitation contrary to parental directives. Eleven cases comprised alleged miscommunication between families and providers. Of these, seven cases alleged inadequate prenatal counseling of infant's chances of survival and neurological outcome, whilst four cases alleged miscommunication of infant's condition post-delivery. CONCLUSIONS: Miscommunication between providers and families during prenatal counseling and after birth was a major component of malpractice cases regarding infants born at the threshold of viability. The infant's immediate post-delivery condition and long term prognosis were of primary interest to parents, and improving effective communication may aid toward more genuinely informed resuscitation directives.