Physician counselling practices and decision-making for extremely preterm infants in the Pacific Rim.
OBJECTIVE
This study was undertaken to evaluate physician counselling practices and resuscitation decisions for extremely preterm infants in countries of the Pacific Rim. We sought to determine the degree to which physician beliefs, parents' opinion and medical resources influence decision-making for infants at the margin of viability.


METHODS
A survey was administered to neonatologists and paediatricians who attend deliveries of preterm infants in Australia, Hong Kong, Japan, Malaysia, Taiwan and Singapore. Questions were asked regarding physician counselling practices, decision-making for extremely preterm infants and demographic information.


RESULTS
Physicians counsel parents antenatally with increasing frequency as gestational age increases. Most physicians discuss infant mortality and morbidity with parents prior to delivery. Physicians less frequently discuss the option of no resuscitation of an extremely preterm infant, withdrawal of support at a later time, or financial costs to parents. Severe congenital malformations, perception of a poor future quality of life, parental wishes and a high probability of death for the infant are influential in limiting resuscitation in very preterm infants for a majority of physicians. Less influential factors are parent socioeconomic status, language barriers, financial costs for the family, allocation of national resources, moral or religious considerations, or fear of litigation. Physician thresholds for resuscitation of infants ranged between 22 and 25 weeks gestation and between 400 and 700 g birthweight.


CONCLUSIONS
We report physician beliefs and practices regarding resuscitation and the counselling of parents of extremely preterm infants in Pacific Rim countries. While we find variation among countries, physician practices appear to be determined by ethical decision-making and medical factors rather than social or economic factors in each country.
Martinez
Alma M
AM
Department of Pediatrics, University of California, San Francisco, San Franscisco, California 94110, USA. amartinez@sfghpeds.ucsf.edu
Partridge
J Colin
JC
Yu
Victor
V
Wee Tan
Keng
K
Yeung
Chap-Yung
CY
Lu
Jen-Her
JH
Nishida
Hiroshi
H
Boo
Nem-Yun
NY
D000328:Adult; D001210:Asia, Southeastern; D003376:Counseling; D003657:Decision Making; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D008297:Male; D009359:Neonatology; D010819:Physician's Role; D010818:Practice Patterns, Physicians'; D012151:Resuscitation / Q000523:psychology*