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

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

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

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

5. 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.

6. CUSS showing IVH and post haemorrhagic ventricular dialatation

7. CUSS showing PVL ( Ischemic white matter damage)

8. Necrotising Enterocolitis

9. RDS with pneumothorax

10. Retinopathy of prematurity

11. Epicure

12. 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%

13. Epicure

14. Epicure 1 – Outcomes at 2yrs

15. 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

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

17. Further information