Attitudes of Australian neonatologists to resuscitation of extremely preterm infants.
OBJECTIVE
We aimed to investigate how Australian neonatologists made decisions when incompetent patients of different ages needed resuscitation.


METHODS
A survey including vignettes of eight incompetent patients requiring resuscitation was sent to 140 neonatologists. Patients ranged from a very preterm infant to 80 years old. While some had existing impairments, all faced risk of death or neurological sequelae. Respondents indicated whether they would resuscitate, whether they believed resuscitation was in the patients' best interests, whether they would want intervention for a family member and whether they would comply with families' wishes to withhold resuscitation. They were also asked how they would rank the eight patients in a triage situation.


RESULTS
Seventy-eight per cent of specialists completed the survey. The majority of respondents gave priority to the resuscitation of children over adults. Less than 40% would agree to withhold resuscitation at families' request for all children except for the preterm infant, where 96% would comply with families' wishes to withhold intensive care despite 77% believing resuscitation to be in the infant's best interest.


CONCLUSIONS
This study found inconsistencies between physicians' perceptions of the patient's best interest regarding resuscitation and their willingness to comply with families' wishes to withhold resuscitation and give comfort care. Accepting a family's refusal of resuscitation was more marked for the premature infant, even among respondents who thought that resuscitation was in the patient's best interest. These findings are consistent with other international studies.
Department of Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.
Bernice A
BA
Mills
Department of Pediatrics and Clinical Ethics, Sainte-Justine Hospital, Université de Montréal, Montréal, Quebec, Canada.
Annie
A
Janvier
Department of Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.
Brenda M
BM
Argus
Department of Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.|Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia.
Peter G
PG
Davis
Department of Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia.|Department of Pediatrics, Innlandet Hospital Trust Lillehammer, Lillehammer, Norway.
Dag Helge
DH
Frøisland
D000328:Adult; D001291:Attitude of Health Personnel; D001315:Australia; D003657:Decision Making; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D008297:Male; D008875:Middle Aged; D009359:Neonatology; D012151:Resuscitation; D011795:Surveys and Questionnaires
best interest; ethics; infant; premature; resuscitation; withholding treatment