Opinions of Brazilian resuscitation instructors regarding resuscitation in the delivery room of extremely preterm newborns.
OBJECTIVE
To describe the opinions of pediatricians who teach resuscitation in Brazil on initiating and limiting the delivery room resuscitation of extremely preterm infants.


METHODS
Cross-sectional study with electronic questionnaire (Dec/2011-Sep/2013) sent to pediatricians who are instructors of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics, containing three hypothetical clinical cases: (1) decision to start the delivery room resuscitation; (2) limitation of neonatal intensive care after delivery room resuscitation; (3) limitation of advanced resuscitation in the delivery room. For each case, it was requested that the instructor indicate the best management for each gestational age between 23 and 26 weeks. A descriptive analysis was performed.


RESULTS
560 (82%) instructors agreed to participate. Only 9% of the instructors reported the existence of written guidelines at their hospital regarding limitations of delivery room resuscitation. At 23 weeks, 50% of the instructors would initiate delivery room resuscitation procedures. At 26 weeks, 2% would decide based on birth weight and/or presence of fused eyelids. Among the participants, 38% would re-evaluate their delivery room decision and limit the care for 23-week neonates in the neonatal intensive care unit. As for advanced resuscitation, 45% and 4% of the respondents, at 23 and 26 weeks, respectively, would not apply chest compressions and/or medications.


CONCLUSIONS
Difficulty can be observed regarding the decision to not resuscitate a preterm infant with 23 weeks of gestational age. At the same time, a small percentage of pediatricians would not resuscitate neonates of unquestionable viability at 26 weeks of gestational age in the delivery room.
Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Universidade Federal de Uberlândia (UFU), Departamento de Pediatria, Uberlândia, MG, Brazil.
Cristiane Ribeiro
CR
Ambrósio
Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Divisão de Medicina Neonatal, São Paulo, SP, Brazil.
Maria Fernanda Branco
MF
de Almeida
Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina, Divisão de Medicina Neonatal, São Paulo, SP, Brazil. Electronic address: ruthgbr@netpoint.com.br.
Ruth
R
Guinsburg
D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D001724:Birth Weight; D001938:Brazil; D003430:Cross-Sectional Studies; D003657:Decision Making; D003696:Delivery Rooms; D005260:Female; D005328:Fetal Viability; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D000072143:Pediatricians / Q000523:psychology*; D011247:Pregnancy; D059285:Pregnancy, Twin; D012151:Resuscitation / Q000193:education / Q000592:standards*; D011795:Surveys and Questionnaires
Bioethics; Bioética; Cardiopulmonary resuscitation; Fetal viability; Newborn infant; Ordens quanto à Conduta (Ética Médica); Recém-nascido; Ressuscitação Cardiopulmonar; Resuscitation orders; Viabilidade Fetal