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Optimizing Shared Decision Making for Neonatal Resuscitation at Periviability.

Luke A Gatta1, Emily A Morris, Allison M McCarthy

  • 1Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the Center for Biomedical Ethics and Society, the Division of Neonatology, Department of Pediatrics, and the Department of Psychiatry and Behavioral Sciences, Vanderbilt University School of Medicine, Nashville, Tennessee.

Obstetrics and Gynecology
|September 26, 2025
PubMed
Summary
This summary is machine-generated.

Shared decision-making is crucial for neonatal resuscitation at the threshold of viability. This review offers best practices for communication, respecting patient autonomy in complex ethical dilemmas.

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Area of Science:

  • Neonatal Medicine
  • Medical Ethics
  • Obstetrics

Background:

  • Periviable births present complex ethical and medical decisions regarding neonatal resuscitation.
  • Implementing shared decision-making (SDM) is challenging due to unpredictable outcomes, variability, and biases.

Purpose of the Study:

  • To explore theoretical foundations, evidence, and best practices for SDM in periviability.
  • To guide clinicians in eliciting patient values and facilitating goal-concordant care.

Main Methods:

  • Review of contemporary evidence and research from palliative and critical care.
  • Emphasis on communication strategies, interdisciplinary collaboration, and scenario-based discussions.
  • Discussion of decision-support tools with caution regarding appropriate application.

Main Results:

  • SDM in periviability requires preparation, interdisciplinary collaboration, and value-elicitation.
  • Risk-benefit statistics may be less effective than scenario-based discussions.
  • Appropriate use of decision aids is crucial.

Conclusions:

  • Effective communication strategies are essential for ethically appropriate care at the threshold of viability.
  • Supporting obstetrician-gynecologists in respecting patient autonomy while maintaining professional integrity.
  • Providing goal-concordant care in emotionally charged periviability settings.