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Physician counselling practices and decision-making for extremely preterm infants in the Pacific Rim
Alma M Martinez1, J Colin Partridge, Victor Yu
1Department of Pediatrics, University of California, San Francisco, San Franscisco, California 94110, USA. amartinez@sfghpeds.ucsf.edu
Journal of Paediatrics and Child Health
|April 9, 2005
Summary
Physician decisions on resuscitating extremely preterm infants in the Pacific Rim are primarily guided by medical and ethical factors, not social or economic ones. Counselling practices vary by gestational age.
Area of Science:
- Neonatal medicine
- Medical ethics
- Perinatal care
Background:
- Extremely preterm infants present complex ethical and medical decisions.
- Physician counselling and resuscitation practices for these infants vary globally.
- Understanding decision-making factors is crucial for improving care at the margin of viability.
Purpose of the Study:
- To evaluate physician counselling and resuscitation decisions for extremely preterm infants in Pacific Rim countries.
- To determine the influence of physician beliefs, parental opinions, and medical resources on these decisions.
- To identify factors influencing decisions for infants at the margin of viability.
Main Methods:
- A survey was administered to neonatologists and pediatricians in Australia, Hong Kong, Japan, Malaysia, Taiwan, and Singapore.
- The survey collected data on physician counselling practices, decision-making for extremely preterm infants, and demographic information.
- Focus was on practices for infants at the threshold of viability.
Main Results:
- Physician counselling frequency increases with gestational age; mortality and morbidity are commonly discussed.
- Discussions on "no resuscitation," withdrawal of support, or costs are less frequent.
- Severe congenital anomalies, perceived quality of life, parental wishes, and high mortality probability significantly influence resuscitation decisions.
- Factors like socioeconomic status, language, costs, national resources, religion, or fear of litigation have less influence.
- Resuscitation thresholds range from 22-25 weeks gestation and 400-700g birthweight.
Conclusions:
- Physician practices and beliefs regarding resuscitation of extremely preterm infants in the Pacific Rim were reported.
- Variations in practices exist among the surveyed countries.
- Decisions are predominantly driven by ethical considerations and medical factors, rather than social or economic influences.