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Opinions of paediatricians who teach neonatal resuscitation about resuscitation practices on extremely preterm infants in the delivery room
  1. Cristiane Ribeiro Ambrosio1,2,
  2. Adriana Sanudo3,
  3. Alma M Martinez4,
  4. Maria Fernanda Branco de Almeida1,
  5. Ruth Guinsburg1
  1. 1Division of Neonatal Medicine, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
  2. 2Department of Pediatrics, Universidade Federal de Uberlândia, Uberlandia, Brazil
  3. 3Department of Preventative Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
  4. 4University of California – San Francisco, San Francisco, USA
  1. Correspondence to Professor Ruth Guinsburg, Division of Neonatal Medicine, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil; ruthgbr{at}netpoint.com.br, ruth.guinsburg{at}unifesp.br

Abstract

Objective To describe the opinions of paediatricians who teach resuscitation in Brazil regarding resuscitation practices in the delivery room (DR) of preterm infants with gestational ages of 23–26 weeks.

Methods Cross-sectional study with an internationally validated electronic questionnaire (December 2011–September 2013) sent to the instructors of the Neonatal Resuscitation Program of the Brazilian Society of Paediatrics on parental counselling practices, medical limits for resuscitation of extremely preterm infants and medical considerations for decision-making in this group of infants. The analysis was descriptive.

Results Among 685 instructors, 560 (82%) agreed to participate. Only 5%–13% reported having opportunity for antenatal counselling parents: if called, 22% reported discussing with the family about the possibility not to resuscitate in the DR; 63% about the possibility of death in the DR and 89% about the possibility of death in the neonatal unit. If the parents did not agree with the advice of the paediatrician, 30%–50% of the respondents would follow the procedures they advised regardless of the opinion of the parents. The higher the gestational age, the lower is the percentage of paediatricians who believed that parents should participate in decision-making. Only 9% participants reported the existence of written guidelines at their hospital on initiation of resuscitation in the DR at limits of viability, but 80% paediatricians reported using some criteria for limiting resuscitation in the DR.

Conclusion The picture obtained in this study of Brazilian paediatricians indicates that resuscitation of extremely preterm infants is permeated by ambivalence and contradictions.

  • Clinical Ethics
  • Decision-making
  • End-of-life
  • Neonatology
  • Perinatal mortality

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Footnotes

  • Contributors CRA, MFBdA and RG: conceptualised and designed the study, collected the data, carried out all study's analyses and data interpretation, drafted the initial manuscript, reviewed and revised the manuscript and approved the final manuscript as submitted. AS: conceptualised and designed the study, carried out all study's analyses and data interpretation, reviewed and revised the manuscript and approved the final manuscript as submitted. AMM: conceptualised the study, reviewed and revised the manuscript and approved the final manuscript as submitted.

  • Competing interests None declared.

  • Ethics approval Ethical Committee on Research of Universidade Federal de São Paulo, São Paulo, Brazil.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement All the database is available at request with the first and last authors of the paper.

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