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Re: Survey: Pre-viable But Living Newborns From: Jerome Yankowitz (jerome-yankowitz@uiowa.edu) Fri May 29 07:28:14 1998 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: John & Sylvia Robertson: "Re: Rhogam after complete mole" Previous message: Myer S. Bornstein: "Re: My case list...TAH in 18yr" In reply to: perinatl@sprynet.com: "Survey: Pre-viable But Living Newborns" Next in thread: Gary Kleinman: "Re: Survey: Pre-viable But Living Newborns" A few things to keep in mind about the questions below: >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? The issues of liveborn, birth and death certificates are still decided state by state despite "standard" definitions by national and international bodies (unless I've fallen behind on the times). For this reason, what others are doing is not completely pertinent unless you are changing state law. To contradict myself, the particulars about who admits is probably up to the obs and pediatricians as I doubt the state gets into this issue. I would sit down and come to a conclusion based on issues like how not to bill the family, coding these kids so they can be wisely evaluated in your hospital and dept statistics (our pediatricians admit the previables with heart beats but not in a way that gets billed--the idea is to more accurately keep statistics. We are particularly interested in the close to viable like 22-23 weeks because as survival improves we want to know "true" survival and not just those that were selectively admitted to the NICU). Also, now-a-days the coding should keep in mind third party payors. Keeping track of these kids may actually be a good idea so you can show that your service is high risk, but not good idea if the stats hint and poor survival. I do think your pediatricians should be more involved and sign the birth and death certificate. A neonatate dying (even previable) is in their specialty more than ours and would fend off other issues. -- Jerome Yankowitz, MD Director, Division of Maternal-Fetal Medicine and Fetal Diagnosis and Treatment Unit Dept of OB/GYN Univ of Iowa Hospitals and Clinics Telephone: 319-356-2574 Fax No: 319-353-6759 Next message: John & Sylvia Robertson: "Re: Rhogam after complete mole" Previous message: Myer S. Bornstein: "Re: My case list...TAH in 18yr" In reply to: perinatl@sprynet.com: "Survey: Pre-viable But Living Newborns" Next in thread: Gary Kleinman: "Re: Survey: Pre-viable But Living Newborns"

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