Published online September 1, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. 679-680 (doi:10.1542/peds.2008-1679)

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LETTER TO THE EDITOR

Resuscitation Decisions for Premature Newborns

Wynne Morrison, MD
Children's Hospital of Philadelphia,
Philadelphia, PA 19104

To the Editor.—

I read with interest the findings of Janvier et al that survey respondents were more likely to defer to a family's request for no resuscitation for patients lacking capacity at the extremes of age (for newborns and for an 80-year-old patient), and that for premature infants respondents would defer to the parents' wishes for no resuscitation even when resuscitation was felt to be in the best interest of the infant.¹

The authors concluded that there is a "reduced value placed on the life of newborns," particularly if they are premature. I would like to speculate on other factors that might contribute to respondents’ being less likely to insist on resuscitation for the premature infants.

Although the authors intentionally assigned the same probability of survival and disability for many of the scenarios, a factor that was not kept constant or made explicit was the potential burdens of therapy. Respondents may have been more willing to accept a family's request for no resuscitation for a premature infant because of the months spent in an ICU on a ventilator that would be required to have a chance of intact survival. They might assume that there would be a much less burdensome (and less resource-intense) hospitalization in the other scenarios. Perhaps the care of premature infants in general is thought to be more likely to involve prolonged suffering.

In addition, the care of premature infants may be seen as more "experimental" than the medical care provided to the other patients. This view could arise because attitudes about premature infants among the general public and physicians in fields other than neonatology has not kept pace with the rapidly improving outcomes in this population. Respondents might have had personal experience with formerly premature infants with poor developmental outcomes or have seen media discussions decrying efforts to "push the envelope" in saving more and more premature infants (eg, http://thepreemieexperiment.blogspot.com). The authors implied that there should be a bias in favor of saving newborns because of the greater number of years of potential life saved, but perhaps respondents were also concerned about a greater number of years lived with possible disability. Many of these unstated factors might play into the decisions made concerning any scenario, rightly or wrongly, no matter how much the researchers try to control all variables.

REFERENCE

1. Janvier A, Leblanc I, Barrington KJ. The best-interest standard is not applied for neonatal resuscitation decisions. Pediatrics. 2008;121 (5):963 –969[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Morrison, W. Search for Related Content PubMed PubMed Citation Articles by Morrison, W. Related Collections Office Practice Social Bookmarking                         What's this?