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Survey: Pre-viable But Living NewbornsFrom: perinatl@sprynet.comFri May 29 03:59:56 1998
I would like to solicit opinions and take a survey about a recurring issue. In this state, a baby born with a heart-beat is considered a live-born, irrespective of gestational age. Hence a 19 week fetus that has a heartbeat for a few minutes after delivery is a liveborn infant and therefore requires a birth certificate and a death certificate. As a matter of local policy, such a newborn is admitted to the hospital as a patient if it has been born in that hospital. There is an on-going debate as to whether such an infant (living but pre-viable) should be admitted by the obstetrician or by the pediatrician/neonatologist. Often, when there is a possibility of survival, say 23 weeks gestation, the neonatologist will attend the delivery and may even attempt a recussitation. If, however, the recussitation is not successful and the infant does not make it to the NICU, the neonatologists will refuse to admit the newborn and request that the newborn be admitted under the name of the delivering obstetrician. My questions: What is the policy in your hospital and what do you think the policy should be concerning the birth of a live but pre-viable infant. i.e., an infant incapable of sustained life outside the uterus because of severe prematurity? - At delivery if the infant has a heart beat but is clearly pre-viable, is it considered a livebirth or a stillbirth? If it might be considered a stillbirth, under what criteria is the distinction made between stillbirth and livebirth -- weight, estimated gestational age, head circumference or other criteria? - Is the infant admitted to the hospital or not? - If admitted, who is the admitting physician or physician of record -- the obstetrician or a pediatrician? - Is a livebirth certificate completed or is a stillbirth certificate (or some other certificate) completed? How is the distinction made as to which certificate to complete. Is a death certificate completed? Who signs these certificates? - How is this birth counted on the hospital statistics? - Are there any other questions or comments on this issue?
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