Attitudes of Neonatologists Toward Delivery Room Management of Confirmed Trisomy 18: Potential Factors Influencing a Changing Dynamic

To the Editor.—

McGraw and Perlman are to be commended for exploring this issue.¹ I agree that a possible explanation for the changing attitude may partly be related to the observation that support for the best-interest standard for neonates is diminishing in favor of parental autonomy. I would contend, however, that in certain circumstances, more intensive intervention can meet both the best-interest-of-the-child standard and the futility-of-care standard.

For trisomy 18, studies have shown that 5% to 10% survive the first year.² Perhaps this low degree of survivability could be called “lethal,” but …