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Survey of neonatologists’ attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit

Journal of Perinatology volume 32, pages 886–892 (2012)Cite this article

Subjects

Abstract

Objective:

To understand neonatologists’ attitudes toward end-of-life (EOL) management in clinical scenarios, EOL ethical concepts and resource utilization.

Study Design:

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.

Result:

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.

Conclusion:

Challenges to providing just, unified EOL care strategies are discussed, including deferring care, limiting artificial nutrition/hydration and conditions surrounding ventilator withdrawal.

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Acknowledgements

We thank NorthShore University HealthSystem's Evanston Hospital's Pediatric Department for funding support, and for the assistance of our colleagues and Mr. James Couto of the AAP. Financial support for this study was provided by the Pediatric Department of NorthShore University HealthSystem's Evanston Hospital in Evanston, IL, USA.

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Authors and Affiliations

  1. Department of Pediatrics, NorthShore University HealthSystem, Evanston, IL, USA

    D M Feltman

  2. Center for Clinical Research Informatics, NorthShore University HealthSystem, Evanston, IL, USA

    H Du

  3. Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA

    S R Leuthner

Authors
  1. D M Feltman
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  2. H Du
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  3. S R Leuthner
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Correspondence to D M Feltman.

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The authors declare no conflict of interest.

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Feltman, D., Du, H. & Leuthner, S. Survey of neonatologists’ attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit. J Perinatol 32, 886–892 (2012). https://doi.org/10.1038/jp.2011.186

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  • DOI: https://doi.org/10.1038/jp.2011.186

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