Original Article

Journal of Perinatology (2007) 27, 754–760; doi:10.1038/sj.jp.7211821; published online 30 August 2007

Decision-making in the delivery room: a survey of neonatologists

A R Weiss1,2, H J Binns1,2,3,4, J W Collins Jr1,2 and R-A deRegnier1,2

  1. 1Pediatrics, Children's Memorial Hospital, Chicago, IL, USA
  2. 2Pediatrics Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
  3. 3Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
  4. 4Mary Ann and J Milburn Smith Child Health Research Program, Children's Memorial Research Center, Chicago, IL, USA

Correspondence: Dr AR Weiss, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA 02462, USA. E-mail: arweiss@partners.org

Received 8 February 2007; Revised 6 July 2007; Accepted 30 July 2007; Published online 30 August 2007.

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Abstract

Objective:

 

To examine influences on neonatologists' decision-making regarding resuscitation of extremely premature infants.

Study Design:

 

A mailed survey of Illinois neonatologists evaluated influences on resuscitation. Personal and parentally opposed (that is, acting against parental wishes) gray zones of resuscitation were defined, with the lower limit (LL) the gestational age at or below which resuscitation would be consistently withheld and the upper limit (UL) above which resuscitation was mandatory.

Result:

 

Among the 85 respondents, LL and UL of the personal and parentally opposed gray zones were median 22 and 25 weeks, respectively. Neonatologists with an UL personal gray zone <25 completed weeks were significantly more fearful of litigation, more likely to have received didactic/continuing medical education teaching, and less likely to always consider parents' opinions in resuscitation decisions. Neonatologists with an UL parentally opposed gray zone <25 completed weeks were more fearful of litigation.

Conclusion:

 

Neonatologists perceive a 'gray zone' of resuscitative practices and should understand that external influences may affect their delivery room resuscitation practices.

Keywords:

decision-making, neonatology, delivery room, resuscitation, prematurity

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