Views and Decisions of Physicians in Encountering Neonates with Poor Prognosis

With the development of neonatal intensive care units (NICUs), new issues have emerged for physicians working in this area, including the ethical aspects of providing invasive and advanced care to neonates with extremely poor prognosis. This research was undertaken with the aim of investing the factors affecting physicians' practice in management of newborns in such complicated circumstances.

A cross-sectional study was carried out over a period of 5 months (Jan 2012 to Jun 2012) in 9 different tertiary levels and academic NICUs affiliated to Tehran University of Medical Sciences in Tehran, Iran. Checklists related to management of 3 hypothetical cases with very poor prognosis and factors affecting pertinent decisions were administered to 88 neonatologists and pediatricians.

Totally, 81.4% of participants approved the use of advanced invasive methods of treatment in the premature neonate. Concerning the neonate with genetic malformations, 51.3% recommended advanced methods. In severe asphyxia, 42.1% disagreed with use of advanced invasive procedures. Overall, 34.2% of the target physicians approved the use of aggressive procedures in all 3 cases. Age, gender, marital status, parental status, and work experience were identified as influencing factors.

With the prediction of acceptable levels of survivability in very premature infants, physicians are more inclined to treat this group. However, they do not favor aggressive measures in infants with severe asphyxia and advanced anomalies.