Babies born at the threshold of viability: attitudes of paediatric consultants and trainees in South East England.
OBJECTIVE
To determine attitudes of paediatric consultants and trainees towards immediate care of babies born at 22-24 weeks gestation.


METHODS
A questionnaire was sent to one consultant and one trainee within each of 63 neonatal units in South East England.


RESULTS
Response rate was 90% (111/123). At 22 weeks gestation, 51% of all respondents would not attend the delivery. At 23 weeks gestation, 63% of respondents would advise against resuscitation during antenatal counselling but 45% would resuscitate despite a parental request for comfort care. Forty-one percent of respondents would provide comfort care for a 23 week gestation baby born in poor condition. If required, 53% of respondents would use chest compressions and/or adrenaline at birth of a 24 week gestation infant (38% consultants, 54% trainees; p = 0.05). More experienced and older paediatricians were more likely to attend 22 week deliveries and be comfortable with parental requests for resuscitation. Fifty-four percent of units had written guidelines on care of these babies. Significantly more consultants (67%) than trainees (25%) correctly classified neonatal deaths.


CONCLUSIONS
Paediatricians with greater experience and age demonstrated more shared decision-making with parents. Nearly half of paediatricians would defy parental wishes at 23 weeks gestation, contrary to ethical recommendations (Nuffield Council on Bioethics, http://www.nuffieldbioethics.org).
Duffy
D
D
Ashford and St Peter's NHS Trust, St Peter's Hospital, Chertsey, Surrey, UK. donovanduffy@doctors.org.uk
Reynolds
P
P
D000367:Age Factors; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D034462:Dissent and Disputes; D004739:England; D005328:Fetal Viability; D005865:Gestational Age; D019538:Health Care Surveys; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011368:Professional-Family Relations; D016414:Resuscitation Orders; D011795:Surveys and Questionnaires; D013997:Time Factors