TY - JOUR
T1 - Physician counselling practices and decision-making for extremely preterm infants in the Pacific Rim
AU - Martinez, Alma M.
AU - Partridge, J. Colin
AU - Yu, Victor
AU - Tan, Keng Wee
AU - Yeung, Chap Yung
AU - Lu, Jen Her
AU - Nishida, Hiroshi
AU - Boo, Nem Yun
N1 - Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2005/4
Y1 - 2005/4
N2 - Objectives: This study was undertaken to evaluate physician counselling practices and resuscitation decisions for extremely preterm infants in countries of the Pacific Rim. We sought to determine the degree to which physician beliefs, parents' opinion and medical resources influence decision-making for infants at the margin of viability. Methods: A survey was administered to neonatologists and paediatricians who attend deliveries of preterm infants in Australia, Hong Kong, Japan, Malaysia, Taiwan and Singapore. Questions were asked regarding physician counselling practices, decision-making for extremely preterm infants and demographic information. Results: Physicians counsel parents antenatally with increasing frequency as gestational age increases. Most physicians discuss infant mortality and morbidity with parents prior to delivery. Physicians less frequently discuss the option of no resuscitation of an extremely preterm infant, withdrawal of support at a later time, or financial costs to parents. Severe congenital malformations, perception of a poor future quality of life, parental wishes and a high probability of death for the infant are influential in limiting resuscitation in very preterm infants for a majority of physicians. Less influential factors are parent socioeconomic status, language barriers, financial costs for the family, allocation of national resources, moral or religious considerations, or fear of litigation. Physician thresholds for resuscitation of infants ranged between 22 and 25 weeks gestation and between 400 and 700 g birthweight. Conclusions: We report physician beliefs and practices regarding resuscitation and the counselling of parents of extremely preterm infants in Pacific Rim countries. While we find variation among countries, physician practices appear to be determined by ethical decision-making and medical factors rather than social or economic factors in each country.
AB - Objectives: This study was undertaken to evaluate physician counselling practices and resuscitation decisions for extremely preterm infants in countries of the Pacific Rim. We sought to determine the degree to which physician beliefs, parents' opinion and medical resources influence decision-making for infants at the margin of viability. Methods: A survey was administered to neonatologists and paediatricians who attend deliveries of preterm infants in Australia, Hong Kong, Japan, Malaysia, Taiwan and Singapore. Questions were asked regarding physician counselling practices, decision-making for extremely preterm infants and demographic information. Results: Physicians counsel parents antenatally with increasing frequency as gestational age increases. Most physicians discuss infant mortality and morbidity with parents prior to delivery. Physicians less frequently discuss the option of no resuscitation of an extremely preterm infant, withdrawal of support at a later time, or financial costs to parents. Severe congenital malformations, perception of a poor future quality of life, parental wishes and a high probability of death for the infant are influential in limiting resuscitation in very preterm infants for a majority of physicians. Less influential factors are parent socioeconomic status, language barriers, financial costs for the family, allocation of national resources, moral or religious considerations, or fear of litigation. Physician thresholds for resuscitation of infants ranged between 22 and 25 weeks gestation and between 400 and 700 g birthweight. Conclusions: We report physician beliefs and practices regarding resuscitation and the counselling of parents of extremely preterm infants in Pacific Rim countries. While we find variation among countries, physician practices appear to be determined by ethical decision-making and medical factors rather than social or economic factors in each country.
KW - Neonatal mortality
KW - Neonatal outcomes
KW - Physician counselling
UR - http://www.scopus.com/inward/record.url?scp=18444384226&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=18444384226&partnerID=8YFLogxK
U2 - 10.1111/j.1440-1754.2005.00589.x
DO - 10.1111/j.1440-1754.2005.00589.x
M3 - Review article
C2 - 15813876
AN - SCOPUS:18444384226
SN - 1034-4810
VL - 41
SP - 209
EP - 214
JO - Journal of Paediatrics and Child Health
JF - Journal of Paediatrics and Child Health
IS - 4
ER -