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Factors Influencing Decision-Making in Neonatology: Inhaled Nitric Oxide in Preterm Infants

OBJECTIVE: We studied decision-making regarding inhaled nitric oxide (iNO) in preterm infants with Pulmonary Hypertension (PH). STUDY DESIGN: We asked members of the AAP-Society of Neonatal-Perinatal Medicine and Division-Chiefs to select from three management options-initiate iNO, engage parents in...

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Autores principales: Manja, Veena, Guyatt, Gordon, Lakshminrusimha, Satyan, Jack, Susan, Kirpalani, Haresh, Zupancic, John A. F., Dukhovny, Dmitry, You, John J., Monteiro, Sandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298829/
https://www.ncbi.nlm.nih.gov/pubmed/30353082
http://dx.doi.org/10.1038/s41372-018-0258-9
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author Manja, Veena
Guyatt, Gordon
Lakshminrusimha, Satyan
Jack, Susan
Kirpalani, Haresh
Zupancic, John A. F.
Dukhovny, Dmitry
You, John J.
Monteiro, Sandra
author_facet Manja, Veena
Guyatt, Gordon
Lakshminrusimha, Satyan
Jack, Susan
Kirpalani, Haresh
Zupancic, John A. F.
Dukhovny, Dmitry
You, John J.
Monteiro, Sandra
author_sort Manja, Veena
collection PubMed
description OBJECTIVE: We studied decision-making regarding inhaled nitric oxide (iNO) in preterm infants with Pulmonary Hypertension (PH). STUDY DESIGN: We asked members of the AAP-Society of Neonatal-Perinatal Medicine and Division-Chiefs to select from three management options-initiate iNO, engage parents in shared-decision-making or not consider iNO in an extremely preterm with PH followed by rating of factors influencing their decision. RESULTS: 304 respondents (9%) completed the survey; 36.5% chose to initiate iNO, 42% to engage parents, and 21.5% did not consider iNO. Provider’s prior experience, safety, and patient-centered care were rated higher by those who initiated or offered iNO; lack of effectiveness and cost-considerations by participants who did not chose iNO. CONCLUSIONS: Most neonatologists offer or initiate iNO therapy based on their individual experience. The minority who chose not to consider iNO placed higher value on lack of effectiveness and cost. These results demonstrate a tension between evidence and pathophysiology-based-therapy/personal experience.
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spelling pubmed-62988292019-04-23 Factors Influencing Decision-Making in Neonatology: Inhaled Nitric Oxide in Preterm Infants Manja, Veena Guyatt, Gordon Lakshminrusimha, Satyan Jack, Susan Kirpalani, Haresh Zupancic, John A. F. Dukhovny, Dmitry You, John J. Monteiro, Sandra J Perinatol Article OBJECTIVE: We studied decision-making regarding inhaled nitric oxide (iNO) in preterm infants with Pulmonary Hypertension (PH). STUDY DESIGN: We asked members of the AAP-Society of Neonatal-Perinatal Medicine and Division-Chiefs to select from three management options-initiate iNO, engage parents in shared-decision-making or not consider iNO in an extremely preterm with PH followed by rating of factors influencing their decision. RESULTS: 304 respondents (9%) completed the survey; 36.5% chose to initiate iNO, 42% to engage parents, and 21.5% did not consider iNO. Provider’s prior experience, safety, and patient-centered care were rated higher by those who initiated or offered iNO; lack of effectiveness and cost-considerations by participants who did not chose iNO. CONCLUSIONS: Most neonatologists offer or initiate iNO therapy based on their individual experience. The minority who chose not to consider iNO placed higher value on lack of effectiveness and cost. These results demonstrate a tension between evidence and pathophysiology-based-therapy/personal experience. 2018-10-23 2019-01 /pmc/articles/PMC6298829/ /pubmed/30353082 http://dx.doi.org/10.1038/s41372-018-0258-9 Text en Users may view, print, copy, and download text and data-mine the content in such documents, for the purposes of academic research, subject always to the full Conditions of use:http://www.nature.com/authors/editorial_policies/license.html#terms
spellingShingle Article
Manja, Veena
Guyatt, Gordon
Lakshminrusimha, Satyan
Jack, Susan
Kirpalani, Haresh
Zupancic, John A. F.
Dukhovny, Dmitry
You, John J.
Monteiro, Sandra
Factors Influencing Decision-Making in Neonatology: Inhaled Nitric Oxide in Preterm Infants
title Factors Influencing Decision-Making in Neonatology: Inhaled Nitric Oxide in Preterm Infants
title_full Factors Influencing Decision-Making in Neonatology: Inhaled Nitric Oxide in Preterm Infants
title_fullStr Factors Influencing Decision-Making in Neonatology: Inhaled Nitric Oxide in Preterm Infants
title_full_unstemmed Factors Influencing Decision-Making in Neonatology: Inhaled Nitric Oxide in Preterm Infants
title_short Factors Influencing Decision-Making in Neonatology: Inhaled Nitric Oxide in Preterm Infants
title_sort factors influencing decision-making in neonatology: inhaled nitric oxide in preterm infants
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6298829/
https://www.ncbi.nlm.nih.gov/pubmed/30353082
http://dx.doi.org/10.1038/s41372-018-0258-9
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