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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Attitudes toward neonatal intensive care treatment of preterm infants with a high risk of developing long-term
Hugh Simon Lam1, Samuel Po Shing Wong, Flora Yuen Big Liu
1Department of Pediatrics, The Chinese University of Hong Kong, Hong Kong, China.
Insights
Parents of preterm infants prioritize saving their babies, even with severe disabilities, more than health workers or mothers of term infants. Religious beliefs and infant health severity significantly influence these life-and-death decisions.
Area of Science:
- Neonatal care decision-making
- Disability attitudes
- Perinatal psychology
Background:
- Understanding attitudes toward disabilities is crucial for neonatal care decision-making.
- Varied perspectives among healthcare workers, mothers of term infants, and parents of preterm infants exist.
Purpose of the Study:
- To compare attitudes toward disabilities among healthcare workers, mothers of term infants, and parents of preterm infants.
- To examine how parental education, religion, and disability severity influence these attitudes.
Main Methods:
- Surveyed 578 subjects: 135 healthcare workers, 155 mothers of term infants, 288 parents of preterm infants.
- Assessed health state rankings, willingness to save infants at all costs, and pivotal risks.
- Analyzed the impact of personal characteristics on decision-making.
Main Results:
- Parents of preterm infants were most likely to save infants at all costs and tolerate severe disabilities.
- Religious worship correlated with higher probability of saving infants and greater risk tolerance.
- Increased neonatal complication severity decreased the likelihood of saving infants at all costs among parents of preterm infants.
Conclusions:
- Parents of preterm infants demonstrate a strong inclination to save their infants, accepting more severe disabilities.
- Individual factors like religious beliefs and the infant's health status significantly shape these attitudes.
- Involving experienced parents of preterm infants in counseling can enhance decision-making support for new parents.
Objectives:
To assess (1) the differences in attitudes toward disabilities of 3 groups of subjects involved in neonatal care decision-making: health care workers, mothers of term infants, and parents of preterm infants, and (2) the impact of subject characteristics on these attitudes including parental education level, religion, and severity of disability.
Methods:
Five hundred seventy-eight subjects were interviewed, of whom 135 were health care workers, 155 were mothers of term infants, and 288 were parents of preterm infants. We assessed between-group differences of the (1) health state ranking permutations, (2) proportion of subjects willing to save the infant at all costs, (3) pivotal risks of each group to the 5 health states comprising varying combinations of mental, physical, and social disabilities, and (4) impact of personal characteristics on decision-making.
Results:
Most health care workers ranked the most severe disability health state as worse than death, whereas most parents of preterm infants ranked death as the worst outcome. Significantly more parents of preterm infants chose to save the infant at all costs, compared with mothers of term infants and health care workers, and the pivotal risks of the parents of preterm infants group were highest for all health states. Religious worship was associated with increased probability of saving at all costs and pivotal risks. Increased severity of neonatal complications was associated with decreased probability of saving at all costs and pivotal risks in parents of preterm infants.
Conclusions:
Our findings suggest that parents of preterm infants as a group were most likely to save the infant at all costs and prepared to tolerate more severe disability health states. However, personal characteristics, in particular religious belief and severity of neonatal complications, have overriding influence on these attitudes. We suggest inclusion of experienced parents of preterm infants for more effective counseling of parents in making life-and-death decisions.
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