title: Resuscitation in the "gray zone" of viability: determining physician preferences and predicting infant outcomes.
abstract: OBJECTIVE
  We assessed physician preferences and physician prognostic abilities regarding delivery room management of exceedingly low birth weight/short gestation infants.
  
  
  METHODS
  We surveyed US neonatologists to assess their behavior in the delivery room when confronted with infants with gestational ages of 22 to 26 weeks. We identified 102 infants in our NICU with birth weights/gestational ages of 400 g/23 weeks to 750 g/26 weeks, whose follow-up care was ensured because of their participation in ongoing clinical trials. We determined 4 proxy measures for "how the infant looked" in the delivery room (Apgar scores at 1 and 5 minutes and heart rates at 1 and 5 minutes) and assessed the predictive value of each marker for subsequent death or neurologic morbidity.
  
  
  RESULTS
  For infants with birth weights of < 500 g and gestational ages of 23 weeks, only 4% of 666 responding neonatologists would provide full resuscitation. In contrast, for infants with birth weights of > 600 g and gestational ages of 25 weeks, > 90% of neonatologists considered resuscitation obligatory. For infants with birth weights of 500 to 600 g and gestational ages of 23 to 24 weeks, only one third of neonatologists responded that parental preference would determine whether they resuscitated the infant in the delivery room. The majority wanted "to see what the infant looked like." For 102 infants with birth weights of < or = 750 g, Apgar scores at 1 and 5 minutes and heart rates at 1 and 5 minutes were neither sensitive nor predictive for death before discharge, survival with a neurologic abnormality, or intact neurologic survival.
  
  
  CONCLUSIONS
  The "gray zone" for delivery room resuscitation seems to be between 500 and 600 g and 23 and 24 weeks. For infants born in that zone, neonatologists' reliance on accurate prediction of death or morbidity in the delivery room may be misplaced.
authors.affiliation: Department of Pediatrics, University of Chicago, 5815 South Maryland Ave, Chicago, IL 60637, USA.
authors.forename: Jaideep
authors.initials: J
authors.lastname: Singh
authors.forename: Jon
authors.initials: J
authors.lastname: Fanaroff
authors.forename: Bree
authors.initials: B
authors.lastname: Andrews
authors.forename: Leslie
authors.initials: L
authors.lastname: Caldarelli
authors.forename: Joanne
authors.initials: J
authors.lastname: Lagatta
authors.forename: Susan
authors.initials: S
authors.lastname: Plesha-Troyke
authors.forename: John
authors.initials: J
authors.lastname: Lantos
authors.forename: William
authors.initials: W
authors.lastname: Meadow
mesh_terms: D001034:Apgar Score; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation; D003657:Decision Making; D003696:Delivery Rooms; D005865:Gestational Age; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D014481:United States