Life-saving therapy for newborns: a questionnaire survey in the state of Massachusetts

The attitudes of Massachusetts pediatricians concerning life-saving therapies for newborns were surveyed. The sample was drawn from the membership list of the Massachusetts Chapter of the American Academy of Pediatrics. Of the sample population of 801 physicians, 449 (56%) responded. Three hypothetical cases were presented with treatment options: (1) An infant with Down syndrome and duodenal atresia, (2) an infant with meningomyelocele and microcephaly and, (3) an extremely low birth weight infant of 700 g and 28 weeks' gestation suffering from birth asphyxia. For case 1, 73% of the physicians recommended surgical correction of the duodenal atresia. Of these, 68% would seek a court order if the parents did not consent to surgery. For case 2, 53% of the physicians recommended surgical repair of the meningomyelocele. For case 3, 90% of the physicians recommended continued resuscitation of the infant and referral to an intensive care unit. Religious affiliation and age were factors influencing these clinical recommendations, with Catholic and younger physicians tending to opt for more aggressive medical intervention. The great majority of physicians (93%) indicated that the economic situation of the family should not affect a decision regarding life-saving therapy. A majority (62%) of the physicians approved of infant care review committees with a primary advisory role. Comparison with earlier attitudinal surveys suggests that pediatricians today are more willing to intervene medically on behalf of infant patients than previously.