Delivery room resuscitation decisions for extremely low birthweight infants in California

Abstract

Objective: To characterize physician-parent counseling and delivery room resuscitation of extremely low birthweight (ELBW) infants.

Study design: Cross-sectional survey of 473 California neonatologists detailing counseling patterns, resuscitation thresholds, and acceptance of parental decision making.

Results: The response rate was 61%. After 23 weeks' gestation, > 80% of neonatologists counseled parents expecting ELBW infants. All (> 99%) counseled parents about mortality; > 25% reported not discussing limiting resuscitation or death despite resuscitation. Decisions to limit resuscitation were affected by congenital anomalies, parents' wishes, or perceptions of pain, suffering, and quality of life. Nearly 70% of neonatologists supported parental decision making at 22 to 23 weeks, whereas 66% to 74% responded that parents should not be allowed to make nonresuscitation decisions after 26 weeks. Median resuscitation thresholds were 23 weeks (range 20-28) and 500 g (range 350-1000).

Conclusions: Neonatologists' failure to discuss nonresuscitation options, variations in resuscitation thresholds, and unwillingness to accept nonresuscitation decisions for more mature ELBW infants may restrict parental decision making.