Challenges in Neonatal counselling - Extreme prematurity Dr.Arun Ramachandran Consultant Neonatologist Singleton Hospital

Challenges When is the best time? Who should counsel parents? What to say? How much information should be given? Evidence based data?

When ? Antenatal Just prior to delivery Immediate postnatal period Repeated postnatal sessions

Who? Obstetrician / Fetal medicine specialist Neonatologist Combined Other specialists eg: Cardiologist

What? What to expect immediately after birth? What is the criteria to resuscitate? System based approach Visiting the unit Information booklet Do not overload with information.

CUSS showing IVH and post haemorrhagic ventricular dialatation

CUSS showing PVL ( Ischemic white matter damage)

Necrotising Enterocolitis

RDS with pneumothorax

Retinopathy of prematurity

Epicure 2 - 2006

Singleton hospital survival data (1997 to 2004) Gestation in weeks Number of babies % 23 6/24 25% 24 21/47 45% 25 34/52 65% 26 55/72 76% 27 90/103 87% 28 90/104 86% 29 117/128 91% 30 124/132 96%

Epicure 2 - 2006

Epicure 1 – Outcomes at 2yrs

Epicure 1 outcomes at 11 years (n=219) 71% of survivors against classmates Combined impairment ( CP + severe or moderate neuromotor impairment + vision + hearing) 45 % in those born at < 26 weeks 1% in classmates

Summary Repeated counselling sessions Pace it to parental demand Continuity of care - Named Consultant and family nurse Written or recorded information Support to family

Further information http://www.epicure.ac.uk/ http://www.bliss.org.uk/