title: Survey of neonatologists' attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit.
abstract: OBJECTIVE
  To understand neonatologists' attitudes toward end-of-life (EOL) management in clinical scenarios, EOL ethical concepts and resource utilization.
  
  
  METHODS
  American Academy of Pediatrics (AAP) Perinatal section members completed an anonymous online survey. Respondents indicated preferences in limiting life-sustaining treatments in four clinical scenarios, ranked agreement with EOL-care ethics statements, indicated outside resources previously used and provided demographic information.
  
  
  RESULTS
  In all, 451 surveys were analyzed. Across clinical scenarios and as general ethical concepts, withdrawal of mechanical ventilation in severely affected patients was most accepted by respondents; withdrawal of artificial nutrition and hydration was least accepted. One-third of neonatologists did not agree that non-initiation of treatment is ethically equivalent to withdrawal. Around 20% of neonatologists would not defer care if uncomfortable with a parent's request. Respondents' resources included ethics committees, AAP guidelines and legal counsel/courts.
  
  
  CONCLUSIONS
  Challenges to providing just, unified EOL care strategies are discussed, including deferring care, limiting artificial nutrition/hydration and conditions surrounding ventilator withdrawal.
authors.affiliation: Department of Pediatrics, NorthShore University HealthSystem, Evanston, IL, USA. dfeltman@northshore.org
authors.forename: D M
authors.initials: DM
authors.lastname: Feltman
authors.forename: H
authors.initials: H
authors.lastname: Du
authors.forename: S R
authors.initials: SR
authors.lastname: Leuthner
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D007363:Intensive Care Units, Neonatal; D008020:Life Support Care / Q000941:ethics / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D009359:Neonatology / Q000941:ethics; D018529:Nutritional Support; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D013727:Terminal Care / Q000941:ethics; D028761:Withholding Treatment / Q000941:ethics / Q000706:statistics & numerical data