This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Abstract
OBJECTIVE. The objective of this study was to determine the attitude of neonatal providers toward delivery room resuscitation of an infant with confirmed trisomy 18 with known congenital heart disease at ≥36 weeks of gestation.
METHODS. A multiple-choice questionnaire listing this clinical scenario was completed by neonatologists and fellows staffing level III NICUs. Potential factors influencing the decision to initiate resuscitation included maternal preference, neonatal condition at birth, obstetric care, and legal concerns.
RESULTS. Fifty-four (76%) of 71 surveys were completed. Of respondents, 44% indicated that they would be willing to initiate resuscitation. Maternal preference (70%) was the primary reason to initiate resuscitation, with the appearance of the neonate in the delivery room (46%) and legal concerns (25%) as additional factors.
CONCLUSIONS. Until recently, there was universal consensus that trisomy 18 was a lethal anomaly for which resuscitation in the delivery room was not indicated. These data indicate that more providers (44%) than anticipated would consider initiation of resuscitation for an infant with trisomy 18 even with congenital heart disease. We speculate that support for the best-interest standard for neonates is diminishing in favor of ceding without question to parental autonomy. This shift may have profound implications for ethical decisions in the NICU.
- Accepted October 5, 2007.
- Copyright © 2008 by the American Academy of Pediatrics
Individual Login
Institutional Login
You may be able to gain access using your login credentials for your institution. Contact your librarian or administrator if you do not have a username and password.
Log in through your institution
Purchase access
In this issue
Jump to section
Related Articles
Cited By...
- Disagreement About Surgical Intervention in Trisomy 18
- Infant With Trisomy 18 and Hypoplastic Left Heart Syndrome
- Childrens Right to Health: Implications for Decision-Making in Newborn Medical Care
- Phenotypic extremes in liveborn monozygotic twins with mosaic Edwards syndrome
- Mortality and Morbidity of VLBW Infants With Trisomy 13 or Trisomy 18
- Tracheostomies and Assisted Ventilation in Children With Profound Disabilities: Navigating Family and Professional Values
- Trisomy 18 and Complex Congenital Heart Disease: Seeking the Threshold Benefit
- The Experience of Families With Children With Trisomy 13 and 18 in Social Networks
- Survey of physicians' approach to severe fetal anomalies
- Trisomy 18 and Trisomy 13: Treatment and Management Decisions
- Antenatal diagnosis of trisomy 18, harm and parental choice
- Is there harm in silence?
- Attitudes of Neonatologists Toward Delivery Room Management of Confirmed Trisomy 18: Potential Factors Influencing a Changing Dynamic
- Attitudes of Neonatologists Toward Delivery Room Management of Confirmed Trisomy 18: Potential Factors Influencing a Changing Dynamic