Babies born at the threshold of viability: attitudes of paediatric consultants and trainees in South East England

Abstract

To determine attitudes of paediatric consultants and trainees towards immediate care of babies born at 22-24 weeks gestation. A questionnaire was sent to one consultant and one trainee within each of 63 neonatal units in South East England. Response rate was 90% (111/123). At 22 weeks gestation, 51% of all respondents would not attend the delivery. At 23 weeks gestation, 63% of respondents would advise against resuscitation during antenatal counselling but 45% would resuscitate despite a parental request for comfort care. Forty-one percent of respondents would provide comfort care for a 23 week gestation baby born in poor condition. If required, 53% of respondents would use chest compressions and/or adrenaline at birth of a 24 week gestation infant (38% consultants, 54% trainees; p = 0.05). More experienced and older paediatricians were more likely to attend 22 week deliveries and be comfortable with parental requests for resuscitation. Fifty-four percent of units had written guidelines on care of these babies. Significantly more consultants (67%) than trainees (25%) correctly classified neonatal deaths. Paediatricians with greater experience and age demonstrated more shared decision-making with parents. Nearly half of paediatricians would defy parental wishes at 23 weeks gestation, contrary to ethical recommendations (Nuffield Council on Bioethics, http://www.nuffieldbioethics.org).