Decision-making in the delivery room: a survey of neonatologists

Abstract

Objective: To examine influences on neonatologists' decision-making regarding resuscitation of extremely premature infants.Study Design: A mailed survey of Illinois neonatologists evaluated influences on resuscitation. Personal and parentally opposed (that is, acting against parental wishes) gray zones of resuscitation were defined, with the lower limit (LL) the gestational age at or below which resuscitation would be consistently withheld and the upper limit (UL) above which resuscitation was mandatory.Result: Among the 85 respondents, LL and UL of the personal and parentally opposed gray zones were median 22 and 25 weeks, respectively. Neonatologists with an UL personal gray zone <25 completed weeks were significantly more fearful of litigation, more likely to have received didactic/continuing medical education teaching, and less likely to always consider parents' opinions in resuscitation decisions. Neonatologists with an UL parentally opposed gray zone <25 completed weeks were more fearful of litigation. Conclusion:Neonatologists perceive a 'gray zone' of resuscitative practices and should understand that external influences may affect their delivery room resuscitation practices.

Opinions of Argentinean neonatologists on the initiation of life‐sustaining treatment in preterm infants

“…Why do less than half of the Argentinean neonatologists surveyed expressed that the local legal framework does not influence their medical decision in the delivery room? It is possible that decisions are more related to other factors, eg, transcendent meaning to life of Argentinean neonatologists, their own experience, or reported outcomes from other studies, rather than to the legal context . Singh et al noted that neonatologists place little emphasis on lawsuits, finding a similar opinion among neonatologists surveyed working in the delivery room …”

“…The survey also investigated the influence of certain sociocultural factors on the clinical decision making of the neonatologists. In particular, the following issues were explored: (1) age; (2) sex; (3) transcendent meaning of life, understood as a meaning of life that exceeds sensible reality and goes beyond this world (that is to say, a meaning of life that derives from the human longing for an answer that goes beyond the limits of space and time); (4) religious beliefs, when present; (5) financial considerations; (6) local legal framework for medical practice in the delivery room; and (7) type of neonatal unit, public, or private …”

Current empirical research in neonatal bioethics

“…Formal ethics teaching during neonatology fellowships also seems to affect the personal ‘grey zone’ of neonatologists (37). Additional ethics training served to lower the upper limit of the physician’s personal grey zone.…”

Flaws in the assessment of the best interests of the newborn

“…The influence of fear of litigation (6) also influences decisions. A recent study showed that most neonatologists deferred to parental requests rather than adhering to their best judgment, whether or not parents requested treatment and whether or not parents were described as litigious (9).…”