Extremely low gestational age neonates and resuscitation: survey on perspectives of Canadian neonatologists

Stacie J. Wood; Kevin Coughlin; Anita Cheng

doi:10.1515/jpm-2022-0089

Article

Extremely low gestational age neonates and resuscitation: survey on perspectives of Canadian neonatologists

Stacie J. Wood , Kevin Coughlin and Anita Cheng

Published/Copyright: July 11, 2022

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From the journal Journal of Perinatal Medicine Volume 50 Issue 9

Abstract

Objectives

Resuscitation care planning for extremely low gestational age neonates (ELGANs) is complex and ethically charged. Increasing survival at lower gestational ages has had a significant impact on this complexity. It also has an impact on healthcare resource utilization and policy development in Canada. This study sought to determine the current attitudes and practices of neonatologists in Canada, and to assess moral distress associated with resuscitation decisions in the ELGAN population. It also aimed to explore the perspectives of adopting a shared decision-making approach where further data with regard to best interests and prognosis are gathered in an individualized manner after birth.

Methods

Neonatologists in Canadian level III NICUs were surveyed in 2020.

Results

Amongst the 65 responses, 78% expressed moral distress when parents request non-resuscitation at 24 weeks. Uncertainty around long-term outcomes in an era with improved chances of morbidity-free survival was the most prominent factor contributing to moral distress. 70% felt less moral distress deciding goals of care after the baby’s initial resuscitation and preferred an individualized approach to palliation decisions based on postnatal course and assessment.

Conclusions

While most current guidelines still support the option of non-resuscitation for infants born at less than 25 weeks, we show evidence of moral distress among Canadian neonatologists that suggests the consideration of routine resuscitation from 24 weeks and above is a more ethical approach in the current era of improved outcomes. Canadian neonatologists identified less moral distress when goals of care are developed postnatally, with availability of more evidence for prognostication, instead of antenatally based primarily on gestational age.

Keywords: clinical; decision making; ethics; extreme prematurity; neonatology; resuscitation

Corresponding author: Dr. Stacie J. Wood, MD, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, E-mail: swood243@uwo.ca

Funding source: Western University Paediatrics Department

Acknowledgments

The authors acknowledge Dr. Michael Miller, PhD, Adjunct Research Professor and Statistician, Department of Paediatrics at Western University for statistical support. The authors thank the Canadian Neonatologists who participated in the survey.

Research funding: This project was supported by a departmental resident research grant, obtained for educational purposes only.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Informed consent was obtained from all participants included in this study.
Ethical approval: The research related to human use has complied with all relevant national regulations, institutional policies, and in accordance with the tenets of the Helsinki Declaration, and has been approved by the Western University Health Sciences Research Ethics Board (Project ID: 114616).

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/jpm-2022-0089).

Received: 2022-02-15

Accepted: 2022-06-11

Published Online: 2022-07-11

Published in Print: 2022-11-25

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https://doi.org/10.1515/jpm-2022-0089

Keywords for this article

clinical; decision making; ethics; extreme prematurity; neonatology; resuscitation