Extremely premature birth and the choice of neonatal intensive care versus palliative comfort care: an 18-year single-center experience.

Objective: Review all live births 22 0/7 through 26 6/7 weeks gestation born 1996 through 2013 at our institution to describe the decision process and immediate outcomes of palliative comfort care (PCC) versus neonatal intensive care (NICU) and whether any significant family complaints or quality assurance concerns arose.

Study Design: Retrospective chart review, physician and ethicist interview process and database review focused upon our established periviability counseling guidelines that are directive of PCC at 22 weeks gestation and NICU at 26 weeks but supportive of informed family choice of either option at 23, 24 and 25 weeks.

Result: At 22 weeks--all 54 infants had PCC; at 23 weeks--29/78 (37%) chose NICU care, 6/29 (21%) infants survived; at 24 weeks--79/108 (73%) chose NICU care, 47/79 (59%) survived; at 25 weeks--147/153 (96%) chose NICU care, 115/147 (78%) survived; and at 26 weeks--all infants had NICU care, 176/203 (87%) survived.

Ethics consultation in Portland. Providence Health's Oregon Region has created an ethics consult service.

In response to the need for a more structured approach toward the enhancement of and preparation for case consultation, the Portland Service Area (PSA) of the Providence Health System Oregon Region implemented a "special team" system. These teams--an extension of the ethics committees already in place--underwent training in areas such as an overview of ethics, patient decision making, professionalism, organizational ethics, and palliative and end-of-life care. Moving ethics consultation away from the purview of ethics committees generally, and into the realm of these trained special teams, has improved PSA's ability to respond to ethics needs in the region.