Document Detail


Attitudes of neonatologists toward delivery room management of confirmed trisomy 18: potential factors influencing a changing dynamic.
MedLine Citation:
PMID:  18519479     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The objective of this study was to determine the attitude of neonatal providers toward delivery room resuscitation of an infant with confirmed trisomy 18 with known congenital heart disease at >/=36 weeks of gestation. METHODS: A multiple-choice questionnaire listing this clinical scenario was completed by neonatologists and fellows staffing level III NICUs. Potential factors influencing the decision to initiate resuscitation included maternal preference, neonatal condition at birth, obstetric care, and legal concerns. RESULTS: Fifty-four (76%) of 71 surveys were completed. Of respondents, 44% indicated that they would be willing to initiate resuscitation. Maternal preference (70%) was the primary reason to initiate resuscitation, with the appearance of the neonate in the delivery room (46%) and legal concerns (25%) as additional factors. CONCLUSIONS: Until recently, there was universal consensus that trisomy 18 was a lethal anomaly for which resuscitation in the delivery room was not indicated. These data indicate that more providers (44%) than anticipated would consider initiation of resuscitation for an infant with trisomy 18 even with congenital heart disease. We speculate that support for the best-interest standard for neonates is diminishing in favor of ceding without question to parental autonomy. This shift may have profound implications for ethical decisions in the NICU.
Authors:
Melanie P McGraw; Jeffrey M Perlman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pediatrics     Volume:  121     ISSN:  1098-4275     ISO Abbreviation:  Pediatrics     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-03     Completed Date:  2008-08-11     Revised Date:  2009-03-30    
Medline Journal Info:
Nlm Unique ID:  0376422     Medline TA:  Pediatrics     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1106-10     Citation Subset:  AIM; IM    
Affiliation:
Division of Newborn Medicine, Weill-Cornell School of Medicine, New York Presbyterian Hospital, 525 East 68th St, Suite N-506, New York, NY 10021, USA.
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MeSH Terms
Descriptor/Qualifier:
Attitude of Health Personnel*
Chromosomes, Human, Pair 18*
Delivery Rooms
Female
Humans
Infant, Newborn
Male
Neonatology*
Questionnaires
Resuscitation*
Trisomy*
Comments/Corrections
Comment In:
Pediatrics. 2009 Mar;123(3):e548-9; author reply e549   [PMID:  19254994 ]
Pediatrics. 2009 Mar;123(3):e547-8; author reply e549   [PMID:  19254993 ]

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