Background Indomethacin prophylaxis reduces important short term outcomes in ELBW infants, however with no effect on BPD or long term neurosensory impairment. Neonatologists are diverse with regard to the utilization of a prophylactic versus treatment strategies in the management of high risk ELBW infants.
Objectives To elicit maternal preferences with regard to indomethacin prophylaxis versus treatment options in ELBW infants utilizing a decision aid tool.
Methods Pregnant women at 23–28 weeks gestation, women of high risk pregnancy and mothers of admitted ELBW infants were enrolled. A computer based interactive decision aid (DA) tool was utilized during interviews. In the first part, the DA provided information with regard to prematurity and various morbidities affecting the preterm infants, then detailed information of pros and cons and prophylactic versus treatment options. In the second part, it coached participants in clarifying values and preferences.
Results Two hundred ninety nine participants were enrolled. Of those; 75% were pregnant women at 23 to 28 weeks, 19% were pregnant of high risk pregnancy and 6% recently had an ELBW infant. 82% of enrolled women preferred a prophylactic indomethacin strategy versus treatment in the management of their infants. When asked about their values, the occurrence of IVH was rated lowest among all other neonatal morbidities affecting the preterm infant.
Conclusion In contrast to neonatal practitioners, mothers strongly preferred an indomethacin prophylactic strategy in the management of preterm infants.
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