Communicating the news of a suspected diagnosis of Down syndrome (DS) at the time of delivery requires an empathic approach that is responsive to the parent's emotional needs and avoids negative bias about the diagnosis.  Parents should be informed of the diagnosis as soon as possible in a private setting that allows them time to process the news, express their emotions, and ask any questions they may have.  Initiating the discussion with statements that frame the diagnosis negatively (eg, "I'm sorry," "I have bad news") should be avoided because they convey implicit bias that the intellectual disability associated with DS is devastating, which may not reflect the parents' values or views about their child.  A shift from "breaking bad news" to "sharing unexpected news" can help prepare the parents to receive the information without imposing negative value judgments.Detailed information about the diagnosis should be tailored to the parents' knowledge base and how much they want to know at this point in time.  The physician should provide information about local resources and support groups and make a plan for follow-up discussion.(Choice A)  This statement uses medical jargon to deliver life-changing news without warning.  Parents should be prepared that unexpected news is coming, and the physician should use language that is easily understood.(Choices C and D)  These statements are not neutral and frame the diagnosis negatively.  Initiating the discussion with "unexpected" rather than "bad" news is preferable.(Choice E)  Sharing alarming news that the baby's examination is abnormal and inquiring if prenatal testing was done is insensitive and may be perceived as judgmental.  When characteristic dysmorphic features of DS are present, it is better to share the findings, explain the diagnosis, and answer any questions the parents may have.Educational objective:Communicating the news of a suspected diagnosis of Down syndrome at the time of delivery requires an empathic approach.  A shift from "breaking bad news" to "sharing unexpected news" can help prepare the parents to receive the information without imposing negative value judgments.

A male newborn, born at 39 weeks gestation, is evaluated in the labor and delivery unit 2 hours after birth.  Prenatal care was limited due to infrequent follow-up, and there were no complications during the delivery.  Apgar scores were 7 and 9 at 1 and 5 minutes, respectively.  Weight is 2.47 kg (5 lbs, 7 oz) and vital signs are normal.  Physical examination shows upslanting palpebral fissures, transverse palmar creasing, and widening of the space between the first and second toes.  The parents share that they are glad the delivery went well.  Which of the following is the most appropriate statement by the physician at this time?

(Choice A)  This statement uses medical jargon to deliver life-changing news without warning.  Parents should be prepared that unexpected news is coming, and the physician should use language that is easily understood.

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A male newborn, born at 39 weeks gestation, is evaluated in the labor and delivery unit 2 hours after birth.  Prenatal care was limited due to infrequent follow-up, and there were no complications during the delivery.  Apgar scores were 7 and 9 at 1 and 5 minutes, respectively.  Weight is 2.47 kg (5 lbs, 7 oz) and vital signs are normal.  Physical examination shows upslanting palpebral fissures, transverse palmar creasing, and widening of the space between the first and second toes.  The parents share that they are glad the delivery went well.  Which of the following is the most appropriate statement by the physician at this time?

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Communicating the news of a suspected diagnosis of Down syndrome (DS) at the time of delivery requires an empathic approach that is responsive to the parent's emotional needs and avoids negative bias about the diagnosis.  Parents should be informed of the diagnosis as soon as possible in a private setting that allows them time to process the news, express their emotions, and ask any questions they may have.  Initiating the discussion with statements that frame the diagnosis negatively (eg, "I'm sorry," "I have bad news") should be avoided because they convey implicit bias that the intellectual disability associated with DS is devastating, which may not reflect the parents' values or views about their child.  A shift from "breaking bad news" to "sharing unexpected news" can help prepare the parents to receive the information without imposing negative value judgments.

Educational objective:Communicating the news of a suspected diagnosis of Down syndrome at the time of delivery requires an empathic approach.  A shift from "breaking bad news" to "sharing unexpected news" can help prepare the parents to receive the information without imposing negative value judgments.

(Choice E)  Sharing alarming news that the baby's examination is abnormal and inquiring if prenatal testing was done is insensitive and may be perceived as judgmental.  When characteristic dysmorphic features of DS are present, it is better to share the findings, explain the diagnosis, and answer any questions the parents may have.

(Choices C and D)  These statements are not neutral and frame the diagnosis negatively.  Initiating the discussion with "unexpected" rather than "bad" news is preferable.

Detailed information about the diagnosis should be tailored to the parents' knowledge base and how much they want to know at this point in time.  The physician should provide information about local resources and support groups and make a plan for follow-up discussion.