title: Views and Decisions of Physicians in Encountering Neonates with Poor Prognosis.
abstract: BACKGROUND
  With the development of neonatal intensive care units (NICUs), new issues have emerged for physicians working in this area, including the ethical aspects of providing invasive and advanced care to neonates with extremely poor prognosis. This research was undertaken with the aim of investing the factors affecting physicians' practice in management of newborns in such complicated circumstances.
  
  
  METHODS
  A cross-sectional study was carried out over a period of 5 months (Jan 2012 to Jun 2012) in 9 different tertiary levels and academic NICUs affiliated to Tehran University of Medical Sciences in Tehran, Iran. Checklists related to management of 3 hypothetical cases with very poor prognosis and factors affecting pertinent decisions were administered to 88 neonatologists and pediatricians.
  
  
  RESULTS
  Totally, 81.4% of participants approved the use of advanced invasive methods of treatment in the premature neonate. Concerning the neonate with genetic malformations, 51.3% recommended advanced methods. In severe asphyxia, 42.1% disagreed with use of advanced invasive procedures. Overall, 34.2% of the target physicians approved the use of aggressive procedures in all 3 cases. Age, gender, marital status, parental status, and work experience were identified as influencing factors.
  
  
  CONCLUSIONS
  With the prediction of acceptable levels of survivability in very premature infants, physicians are more inclined to treat this group. However, they do not favor aggressive measures in infants with severe asphyxia and advanced anomalies.
authors.affiliation: Family Health Institute, Maternal-Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Nayeri
authors.affiliation: Medical ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Fariba
authors.initials: F
authors.lastname: Asghari
authors.affiliation: Pediatric Department, Arak University of Medical Sciences, Arak, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Baser
authors.affiliation: Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Leila
authors.initials: L
authors.lastname: Janani
authors.affiliation: Family Health Institute, Maternal-Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mamak
authors.initials: M
authors.lastname: Shariat
authors.affiliation: Family Health Institute, Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Bita
authors.initials: B
authors.lastname: Eabrhim
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000367:Age Factors; D001238:Asphyxia Neonatorum / Q000628:therapy*; D001291:Attitude of Health Personnel; D057189:Checklist; D000066491:Clinical Decision-Making; D000013:Congenital Abnormalities / Q000628:therapy*; D000072700:Conservative Treatment; D003430:Cross-Sectional Studies; D019468:Disease Management; D005260:Female; D030342:Genetic Diseases, Inborn / Q000628:therapy*; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D007492:Iran; D008297:Male; D017533:Marital Status; D000072156:Neonatologists; D010166:Palliative Care; D010290:Parents; D000072143:Pediatricians; D011379:Prognosis; D012151:Resuscitation; D016414:Resuscitation Orders; D012720:Severity of Illness Index; D012737:Sex Factors; D011795:Surveys and Questionnaires