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ARTICLES: Jaideep Singh, Jon Fanaroff, Bree Andrews, Leslie Caldarelli, Joanne Lagatta, Susan Plesha-Troyke, John Lantos, and William Meadow Resuscitation in the "Gray Zone" of Viability: Determining Physician Preferences and Predicting Infant Outcomes Pediatrics 2007; 120: 519-526 [Abstract] [Full text] [PDF]

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findings consistent with clinical practice

Mark E Anderson, Mark S. Gaylord, MD   (18 September 2007)

Periviability Guidelines are helpful and rational

Joseph W Kaempf   (1 October 2007)

findings consistent with clinical practice 18 September 2007
Mark E Anderson, Neonatologist University of Tennessee Medical Center, Knoxville, Mark S. Gaylord, MD Send letter to journal: Re: findings consistent with clinical practice manderso{at}mc.utmck.edu Mark E Anderson, et al.	We read with delight the article by Singh, et al. Their findings confirm a long held view of ours and we would like to rephrase their conclusions with our interpretation. To wit, the delivery room is the WORST place to decide if resuscitation should be attempted. For extremely preterm babies, the one minute Apgar score is terrible at discerning whether a baby will live or die. The practice of waiting for a baby to ‘declare’ himself guarantees two things: 1) injury, perhaps irreparable, may occur while the neonatologist is deciding whether a heart rate of 60 is a red light or a green one; and 2) the mind set that says “let’s wait and see,” will lead to lack of proper preparation and indecision throughout the entire resuscitation process. We feel the most appropriate time to decide on aggessive life support for this subset of babies is in the mother’s room prior to delivery. The second best time is in the NICU after further clinical data is available. The worst time is immediately following delivery. Conflict of Interest: None declared
Periviability Guidelines are helpful and rational 1 October 2007
Joseph W Kaempf, Neonatologist Providence St. Vincent Medical Center Send letter to journal: Re: Periviability Guidelines are helpful and rational joe{at}nnspc.com Joseph W Kaempf	We appreciate the publication by Dr. Singh et al demonstrating the futility of using the initial condition of the extremely premature infant as an accurate marker of mortality or severe neurologic morbidity. We were surprised their manuscript did not cite our work that describes periviability guidelines (Pediatrics 2006;117:22-29). This was precisely our point - decisions regarding resuscitation of extremely premature infants are most rationally made after a) consensus guidelines are developed for each gestational age and, b) discussion of such guidelines occur with the family before delivery of the infant. Physicians deciding which extremely premature infants should have prolonged NICU care based on their appearance in the delivery room is a) error prone as Dr. Singh points out, and b) unreasonable as we point out. Conflict of Interest: None declared

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