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Delivery room decision-making at the threshold of viability
Jehanna M Peerzada1, Douglas K Richardson, Jeffrey P Burns
1Department of Medicine, Harvard Medical School and Children's Hospital, Boston, USA. jpeerzada@cc.nih.gov <jpeerzada@cc.nih.gov>
Objectives:
To assess attitudes of neonatologists toward parental wishes in delivery room resuscitation decisions at the threshold of viability.
Study Design:
Cross-sectional survey of the 175 practicing level II/III neonatologists in six New England states.
Results:
Response rate was 85% (149/175). At 24 1/7-6/7 weeks' gestation, 41% of neonatologists considered treatment clearly beneficial, and at 25 1/7-6/7 weeks' gestation, 84% considered treatment clearly beneficial. When respondents consider treatment clearly beneficial, 91% reported that they would resuscitate in the delivery room despite parental requests to withhold. At or below 23 0/7 weeks' gestation, 93% of neonatologists considered treatment futile. Thirty-three percent reported that they would provide what they consider futile treatment at parental request. When respondents consider treatment to be of uncertain benefit, all reported that they would resuscitate when parents request it, 98% reported that they would resuscitate when parents are unsure, and 76% reported that they would follow parental requests to withhold.
Conclusions:
Variation in neonatologists' beliefs about the gestational age bounds of clearly beneficial treatment and attitudes toward parental wishes in the context of uncertainty is likely to impact the manner in which they discuss options with parents before delivery. This supports the importance of transparency in neonatal decision-making.