Related Experiment Videos
Physicians' neonatal resuscitation of extremely low-birth-weight preterm infants
1Napa Valley College, Napa, California, USA. acatlin@napanet.net
Insights
Physicians generally resuscitated extremely low-birth-weight (ELBW) neonates despite high risks, driven by professional duty and uncertainty. They advocate for clearer guidelines on resuscitation for marginal viability cases.
Area of Science:
- Neonatal Medicine
- Medical Ethics
- Perinatal Care
Background:
- Delivery room decisions for extremely low-birth-weight (ELBW) neonates at marginal viability are complex and ethically debated.
- High rates of morbidity and mortality in ELBW neonates prompt scrutiny of resuscitation practices by various stakeholders.
- Limited research exists on physicians' perspectives and decision-making processes in these critical neonatal resuscitation scenarios.
Purpose of the Study:
- To investigate the perceptions of physicians involved in delivery room resuscitation decisions for extremely low-birth-weight (ELBW) neonates.
- To understand the factors influencing physicians' choices to resuscitate or not resuscitate ELBW neonates at the threshold of viability.
Main Methods:
- A descriptive study employing naturalistic inquiry.
- Data collected through tape-recorded and transcribed interviews with 54 physicians across five perinatal subspecialties in the U.S.
- Interviews analyzed using NUD*IST software and constant comparative analysis.
Main Results:
- 96% of physicians offered resuscitation to all ELBW neonates, irrespective of high morbidity/mortality risks.
- Key decision factors included professional role expectations ('trained to save lives'), parental requests, and inability to determine gestational age.
- Physicians reported significant burdens from caring for non-survivors and uncertainty in predicting outcomes; survival statistics, legal, and cost factors had minimal impact.
Conclusions:
- The current Neonatal Resuscitation Protocol requires revision to include explicit ethical criteria for resuscitation decisions.
- Enhanced prenatal education for families on viability margins and outcomes is recommended.
- Support is needed for physicians to navigate and potentially alter the established resuscitation paradigm.
Purpose:
To examine the perceptions of physicians who make delivery room decisions to resuscitate extremely low-birth-weight (ELBW) neonates at marginal viability. Nurses, parents, economists, and ethicists have questioned resuscitation of ELBW neonates, many of whom experience high levels of morbidity and mortality. Yet no systematic studies were found that addressed physicians' perceptions and delivery room decisions.
Design:
Descriptive, using naturalistic inquiry. A national U.S. convenience sample was obtained in 1996-1997 of 54 physicians in five perinatal subspecialties who resuscitated ELBW neonates.
Methods:
Tape-recorded and transcribed interviews were analyzed using NUD*IST software and line-by-line constant comparison.
Findings:
Despite awareness of the high morbidity and mortality, 96 percent of the physicians offered resuscitation to all ELBW neonates in the delivery room. The main factors affecting their decisions were "the role of the physician;" having been "trained to save lives;" the belief that "if called, I resuscitate;" the inability to determine gestational age; requests from parents to "do everything;" and the need to move from a "chaotic" delivery room to a controlled neonatal intensive care unit. Six major themes were: role expectation, uncertainty, awareness, internal and external forces, burden, and continuing quandaries. Physicians were burdened by the devastated and dying babies, by their inability to predict which neonates had a chance for intact survival, and by conflicts with colleagues about viability. Statistical probability of survival, legal constraints, and cost of care did not appear to affect greatly their decisions. Physicians asked that society and national policy makers set parameters for resuscitation.
Conclusions:
The American Academy of Pediatrics' Neonatal Resuscitation Protocol needs revision to delineate the ethical criteria for resuscitation. Early prenatal education for families which clearly teaches the margins of viability and outcomes of early deliveries is also recommended. Physicians must be supported in changing the resuscitation paradigm.