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Babies born at the threshold of viability: attitudes of paediatric consultants and trainees in South East England

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Abstract:

Abstract Aim: 

To determine attitudes of paediatric consultants and trainees towards immediate care of babies born at 22–24 weeks gestation. Methods: 

A questionnaire was sent to one consultant and one trainee within each of 63 neonatal units in South East England. Results: 

Response rate was 90% (111/123). At 22 weeks gestation, 51% of all respondents would not attend the delivery. At 23 weeks gestation, 63% of respondents would advise against resuscitation during antenatal counselling but 45% would resuscitate despite a parental request for comfort care. Forty-one percent of respondents would provide comfort care for a 23 week gestation baby born in poor condition. If required, 53% of respondents would use chest compressions and/or adrenaline at birth of a 24 week gestation infant (38% consultants, 54% trainees; p = 0.05). More experienced and older paediatricians were more likely to attend 22 week deliveries and be comfortable with parental requests for resuscitation. Fifty-four percent of units had written guidelines on care of these babies. Significantly more consultants (67%) than trainees (25%) correctly classified neonatal deaths. Conclusions: 

Paediatricians with greater experience and age demonstrated more shared decision-making with parents. Nearly half of paediatricians would defy parental wishes at 23 weeks gestation, contrary to ethical recommendations (Nuffield Council on Bioethics, http://www.nuffieldbioethics.org).

Keywords: Attitudes; Decision-making; Extremely preterm infants; Resuscitation; Training

Document Type: Research Article

DOI: https://doi.org/10.1111/j.1651-2227.2010.01975.x

Publication date: 2011-01-01

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