Published online November 1, 2006
PEDIATRICS Vol. 118 Supplement November 2006, pp. S169-S176 (doi:10.1542/peds.2006-0913O)

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ARTICLE

Attitudes of Obstetric and Pediatric Health Care Providers Toward Resuscitation of Infants Who Are Born at the Margins of Viability

Justin P. Lavin, Jr, MD^a, Anand Kantak, MD^b, Judy Ohlinger, RNC, MSN^c, Joseph W. Kaempf, MD^d, Mark Tomlinson, MD^e, Betty Campbell, RN, BSN^f, Ona Fofah, MD^g, William Edwards, MD^h, Kathy Allbright, RNⁱ, Erik Hagen, MD^j, Gautham Suresh, MD^k and Janice Schriefer, DrPH^l

^a Divisions of Maternal Fetal Medicine
^b Neonatology
^c Department of Nursing, Akron Children's Hospital and Akron General Medical Center and Summa Health System, Akron, Ohio
^d Divisions of Neonatology
^e Maternal-Fetal Medicine
^f Department of Nursing, Providence St Vincent Medical Center, Portland, Oregon
^g Division of Neonatology, Rockford Memorial Hospital, Rockford, Illinois
^h Division of Neonatology
ⁱ Department of Nursing, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
^j Division of Neonatology, Children's Hospitals and Clinics and United Hospital Birth Center, St Paul, Minnesota
^k Division of Neonatology, Medical University of South Carolina, Charleston, South Carolina
^l Vermont Oxford Network, Burlington, Vermont

OBJECTIVES. The objective of this study was to determine the attitudes of a variety of health care providers toward the recommendations that should be made to parents regarding the resuscitation of infants who are born at the margins of viability.

METHODS. A written questionnaire was distributed to the medical and nursing staff at 4 tertiary perinatal centers. For each of 5 weekly gestational age intervals from 22 weeks to 26 weeks, 6 days, the health care providers were asked to describe on a scale from 1 to 5 whether they would strongly discourage through strongly encourage resuscitation. They also were queried regarding their comfort with counseling regarding these issues. The attitudes of various groups of providers were compared across weekly intervals.

RESULTS. A total of 204 physicians and 539 nurses completed the survey. The majority would strongly discourage, either discourage or strongly discourage, be neutral or recommend, recommend or strongly recommend, and strongly recommend resuscitation during the 23rd, 24th, 25th, 26th, and 27th weeks of gestation, respectively. Obstetric caregivers were slightly less likely than pediatric caregivers to strongly discourage resuscitation from 22 weeks to 22 weeks, 6 days and 23 weeks to 23 weeks, 6 days. There were no significant differences in the recommendations of obstetricians and pediatricians. Pediatric nurses were more likely to strongly recommend resuscitation from 26 weeks to 26 weeks, 6 days and more likely either to discourage or to strongly discourage resuscitation from 23 weeks to 23 weeks, 6 days and to strongly discourage resuscitation from the 22 weeks to 22 weeks, 6 days than their obstetric counterparts. Obstetric nurses were slightly less likely than obstetricians to strongly recommend resuscitation at 26 weeks to 26 weeks, 6 days and less likely to strongly discourage resuscitation from 22 weeks to 22 weeks, 6 days.

CONCLUSIONS. The caregivers' recommendations seem to be based logically on the current literature regarding survival and morbidity that is experienced by infants who are born at the threshold of viability. Although there are minor differences, there was a relatively consistent approach among professional groups.

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Key Words: margins of viability • neonatal resuscitation • patient counseling

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Accepted Jul 18, 2006.

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