Published online May 26, 2009
PEDIATRICS Vol. 123 No. 6 June 2009, pp. 1501-1508 (doi:10.1542/peds.2008-2061)
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ARTICLE

Attitudes Toward Neonatal Intensive Care Treatment of Preterm Infants With a High Risk of Developing Long-term Disabilities

Hugh Simon Lam, MRCPCHa, Samuel Po Shing Wong, PhDb, Flora Yuen Big Liu, BNura, Hiu Lei Wong, MRCPa, Tai Fai Fok, MDa and Pak Cheung Ng, MDa

a Departments of Pediatrics
b Statistics, The Chinese University of Hong Kong, Hong Kong, China

OBJECTIVES. To assess (1) the differences in attitudes toward disabilities of 3 groups of subjects involved in neonatal care decision-making: health care workers, mothers of term infants, and parents of preterm infants, and (2) the impact of subject characteristics on these attitudes including parental education level, religion, and severity of disability.

METHODS. Five hundred seventy-eight subjects were interviewed, of whom 135 were health care workers, 155 were mothers of term infants, and 288 were parents of preterm infants. We assessed between-group differences of the (1) health state ranking permutations, (2) proportion of subjects willing to save the infant at all costs, (3) pivotal risks of each group to the 5 health states comprising varying combinations of mental, physical, and social disabilities, and (4) impact of personal characteristics on decision-making.

RESULTS. Most health care workers ranked the most severe disability health state as worse than death, whereas most parents of preterm infants ranked death as the worst outcome. Significantly more parents of preterm infants chose to save the infant at all costs, compared with mothers of term infants and health care workers, and the pivotal risks of the parents of preterm infants group were highest for all health states. Religious worship was associated with increased probability of saving at all costs and pivotal risks. Increased severity of neonatal complications was associated with decreased probability of saving at all costs and pivotal risks in parents of preterm infants.

CONCLUSIONS. Our findings suggest that parents of preterm infants as a group were most likely to save the infant at all costs and prepared to tolerate more severe disability health states. However, personal characteristics, in particular religious belief and severity of neonatal complications, have overriding influence on these attitudes. We suggest inclusion of experienced parents of preterm infants for more effective counseling of parents in making life-and-death decisions.

Key Words: attitudes • decision-making • neonatal disabilities • pivotal risk

Abbreviations: HCW—health care worker • FP—father of preterm infant • MT—mother of term infant • MP—mother of preterm infant • PP—parent of preterm infant • SIS—severity-of-illness score

Accepted Sep 29, 2008.


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