Survey of neonatologists’ attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit

Feltman, Dalia M.; Du, Hongwu; Leuthner, Steven R.

doi:10.1038/jp.2011.186

Cited by 49 publications

(24 citation statements)

References 21 publications

(21 reference statements)

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“…First, the response rate was 19%. While this is within range of typical response rate reported by the SONPM of the AAP (10-15%) and similar to other published surveys based on SONPM members (17), this low response rate may lead to bias in our conclusions. Second, the generalisability of our survey is also limited by the fact that only 50% of U.S. neonatologists belong to the SONPM of the AAP.…”

Section: Discussionsupporting

confidence: 88%

Neonatal therapeutic hypothermia outside of standard guidelines: a survey of U.S. neonatologists

Burnsed

Zanelli

2017

Acta Paediatrica

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Section: Discussionsupporting

confidence: 88%

Neonatal therapeutic hypothermia outside of standard guidelines: a survey of U.S. neonatologists

Burnsed

Zanelli

2017

Acta Paediatrica

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“…Oman, Turkey 3,5,10,18 and was converse with the study in the USA. 22 In general, from the findings of this study it is inferred that the participants supported the use of all therapeutic measures for neonates with poor prognosis, that is against the perspective of active euthanasia in clinical practice. While withholding and withdrawing intensive neonatal care in the UK is not uncommon 17 , the British Medical Association repeatedly reinforces the rejection of active euthanasia.…”

Section: Disscusionmentioning

confidence: 63%

Physicians and nurses’ perspectives of encountering neonates with poor prognosis

Rafiee

Rabiei

Rafati³

et al. 2020

Preprint

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Introduction: Decision making regarding the treatment of neonates with poor prognoses is difficult for healthcare staff working in the neonatal intensive care unit (NICU). This study aimed to investigate the attitude of physicians and nurses towards the value of life and ethical decision making when encountering neonates with poor prognosis in the NICU. Methods: A cross-sectional study was conducted in 2016. This study was carried out in five NICUs of five hospitals in Tehran city, Iran. The perspectives of 144 paediatricians, gynaecologist and nurses were assessed using the questionnaire of attitude toward the value of life and agreement on intensive care management on three hypothetical cases scenarios of neonates with poor prognosis. Data was analysed using descriptive and inferential statistics. Results: The negative agreement on the no initiation of intensive care measures and the discontinuation of resuscitation in neonates with poor prognosis was more than the positive agreement. Also, various factors influenced the participants’ decision making for the provision of care to neonates. Regarding the case scenarios, the participants agreed on the provision of aggressive, conservative, and palliative care with various frequencies. This study confirms the importance of healthcare providers’ perspectives and their impacts on ethical decision making. The participants in this study favoured the value or sacredness of life and agreed on the use of all therapeutic measures for neonates with poor prognosis. Conclusion: More studies are required to improve our understandings of factors influencing ethical decision makings by healthcare providers when encountering neonates with poor prognosis in NICUs. Key words: Decision making, ethics, neonatal intensive care unit, poor prognosis, value of life

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“…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 …”

Section: Discussionmentioning

confidence: 99%

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

Silberberg

Villar

Torres

2018

Health Science Reports

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BackgroundIn June 2014, the Argentinean Ministry of Health published guidelines for the management of neonates born at the limit of viability (≤25 weeks of gestation). We explored the opinion of neonatologists in Buenos Aires, Argentina, regarding the initiation of life‐sustaining treatment (LST) in critically ill neonates, focusing on the effect of sociocultural factors on their opinion.MethodsAn anonymous survey was designed to explore the opinions of Argentinean neonatologists on whether or not to initiate LST in newborns born prematurely. Five hundred eighty neonatologists from 36 neonatal units were invited to participate, and 315 specialists from 34 neonatal units completed the survey (response rate 54%). The survey was conducted between June 2014 and February 2015.Results9.5% (30/315) of the neonatologists answered they would begin LST on neonates born at 22 weeks, 42.5% (134/315) at 23 weeks, 37% (117/315) at 24 weeks, 7% (22/315) at 25 weeks, and 4% (12/315) at ≥26 weeks. Cumulatively then, 96% of participants stated they would start LST at 25 weeks of gestation or less. On multivariate analysis, a “transcendent” value of life and lack of consideration of the local legal framework for making medical decisions in the delivery room were statistically associated with an opinion in favor of initiation of LST in neonates born at the limit of viability. More than 50% of the Argentinean neonatologists surveyed answered they would initiate treatment at a gestational age of less than 23 weeks, despite the fact that the recommendations of the Argentinean Ministry of Health are to only give comfort care for these neonates. The opinion of most Argentinean neonatologists surveyed thus differs from that recommended by the guidelines of Argentina.ConclusionThe most frequent opinion of Argentinean neonatologists was to initiate LST in neonates at the limit of viability. Certain factors, in particular the sense of a transcendent meaning to life and lack of consideration of the local legal framework for making medical decisions in the delivery room, seem to influence the decision to start LST.

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Survey of neonatologists’ attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit

Cited by 49 publications

References 21 publications

Neonatal therapeutic hypothermia outside of standard guidelines: a survey of U.S. neonatologists

Neonatal therapeutic hypothermia outside of standard guidelines: a survey of U.S. neonatologists

Physicians and nurses’ perspectives of encountering neonates with poor prognosis

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

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