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Neonatologists’ Resuscitation Decisions at Birth for Extremely Premature Infants. A Belgian Qualitative Study

OBJECTIVE: Deciding whether initiating or withholding resuscitation at birth for extremely preterm infants (EPIs) can be difficult due to uncertainty on outcomes. Clinical uncertainty generates ethical uncertainty. Thus, physicians’ attitudes and perspectives on resuscitation of EPIs might influence...

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Autores principales: Cavolo, Alice, Dierckx de Casterlé, Bernadette, Naulaers, Gunnar, Gastmans, Chris
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8989134/
https://www.ncbi.nlm.nih.gov/pubmed/35402353
http://dx.doi.org/10.3389/fped.2022.852073
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author Cavolo, Alice
Dierckx de Casterlé, Bernadette
Naulaers, Gunnar
Gastmans, Chris
author_facet Cavolo, Alice
Dierckx de Casterlé, Bernadette
Naulaers, Gunnar
Gastmans, Chris
author_sort Cavolo, Alice
collection PubMed
description OBJECTIVE: Deciding whether initiating or withholding resuscitation at birth for extremely preterm infants (EPIs) can be difficult due to uncertainty on outcomes. Clinical uncertainty generates ethical uncertainty. Thus, physicians’ attitudes and perspectives on resuscitation of EPIs might influence resuscitation decisions. We aimed at understanding how neonatologists make clinical-ethical decisions for EPI resuscitation and how they perceive these decisions. METHODS: We performed a qualitative study using a constructivist account of grounded theory. Face-to-face, semi-structured in-depth interviews with neonatologists comprised data collection. For data analysis, we used the Qualitative Analysis Guide of Leuven. RESULTS: We interviewed 20 neonatologists working in 10 hospitals in Belgium. Participants’ decision-making can be described as consensus-based, gestational age-based, contextualized, progressive, and shared. All participants agreed on the importance of using the consensus expressed in guidelines as a guidance for the decision-making, i.e., consensus-based. Consequently, all 20 participants use GA thresholds indicated in the guidelines, i.e., GA-based. However, they use these thresholds differently in their decisions. Few participants rigidly follow established thresholds. The vast majority reported using additional contextual factors as birthweight or parents’ wishes in the decision-making, rather than only the EPIs’ GA, i.e., contextualized. All participants agreed on the importance of involving the parents in the decision-making, i.e., shared, and indeed parents’ wishes were among the most valued factors considered in the decision-making. However, the extent to which parents were involved in the decision-making depended on the infant’s GA. Participants described a gray zone in which parents’ were viewed as the main decision-makers due to the high clinical uncertainty. This mean that participants tend to follow parents’ request even when they disagree with it. Outside the gray zone, physicians were viewed as the main decision-makers. This mean that, although parents’ wishes were still considered, counseling was more directive and the final decision was made by the physician. CONCLUSION: Although an EPI’s GA remains the main factor guiding neonatologists’ resuscitation decisions, other factors are seriously considered in the decision-making process. All neonatologist participants agreed on the importance of involving parents in the decision-making. However, they involve parents differently depending on the EPI’s GA.
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spelling pubmed-89891342022-04-08 Neonatologists’ Resuscitation Decisions at Birth for Extremely Premature Infants. A Belgian Qualitative Study Cavolo, Alice Dierckx de Casterlé, Bernadette Naulaers, Gunnar Gastmans, Chris Front Pediatr Pediatrics OBJECTIVE: Deciding whether initiating or withholding resuscitation at birth for extremely preterm infants (EPIs) can be difficult due to uncertainty on outcomes. Clinical uncertainty generates ethical uncertainty. Thus, physicians’ attitudes and perspectives on resuscitation of EPIs might influence resuscitation decisions. We aimed at understanding how neonatologists make clinical-ethical decisions for EPI resuscitation and how they perceive these decisions. METHODS: We performed a qualitative study using a constructivist account of grounded theory. Face-to-face, semi-structured in-depth interviews with neonatologists comprised data collection. For data analysis, we used the Qualitative Analysis Guide of Leuven. RESULTS: We interviewed 20 neonatologists working in 10 hospitals in Belgium. Participants’ decision-making can be described as consensus-based, gestational age-based, contextualized, progressive, and shared. All participants agreed on the importance of using the consensus expressed in guidelines as a guidance for the decision-making, i.e., consensus-based. Consequently, all 20 participants use GA thresholds indicated in the guidelines, i.e., GA-based. However, they use these thresholds differently in their decisions. Few participants rigidly follow established thresholds. The vast majority reported using additional contextual factors as birthweight or parents’ wishes in the decision-making, rather than only the EPIs’ GA, i.e., contextualized. All participants agreed on the importance of involving the parents in the decision-making, i.e., shared, and indeed parents’ wishes were among the most valued factors considered in the decision-making. However, the extent to which parents were involved in the decision-making depended on the infant’s GA. Participants described a gray zone in which parents’ were viewed as the main decision-makers due to the high clinical uncertainty. This mean that participants tend to follow parents’ request even when they disagree with it. Outside the gray zone, physicians were viewed as the main decision-makers. This mean that, although parents’ wishes were still considered, counseling was more directive and the final decision was made by the physician. CONCLUSION: Although an EPI’s GA remains the main factor guiding neonatologists’ resuscitation decisions, other factors are seriously considered in the decision-making process. All neonatologist participants agreed on the importance of involving parents in the decision-making. However, they involve parents differently depending on the EPI’s GA. Frontiers Media S.A. 2022-03-24 /pmc/articles/PMC8989134/ /pubmed/35402353 http://dx.doi.org/10.3389/fped.2022.852073 Text en Copyright © 2022 Cavolo, Dierckx de Casterlé, Naulaers and Gastmans. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Cavolo, Alice
Dierckx de Casterlé, Bernadette
Naulaers, Gunnar
Gastmans, Chris
Neonatologists’ Resuscitation Decisions at Birth for Extremely Premature Infants. A Belgian Qualitative Study
title Neonatologists’ Resuscitation Decisions at Birth for Extremely Premature Infants. A Belgian Qualitative Study
title_full Neonatologists’ Resuscitation Decisions at Birth for Extremely Premature Infants. A Belgian Qualitative Study
title_fullStr Neonatologists’ Resuscitation Decisions at Birth for Extremely Premature Infants. A Belgian Qualitative Study
title_full_unstemmed Neonatologists’ Resuscitation Decisions at Birth for Extremely Premature Infants. A Belgian Qualitative Study
title_short Neonatologists’ Resuscitation Decisions at Birth for Extremely Premature Infants. A Belgian Qualitative Study
title_sort neonatologists’ resuscitation decisions at birth for extremely premature infants. a belgian qualitative study
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8989134/
https://www.ncbi.nlm.nih.gov/pubmed/35402353
http://dx.doi.org/10.3389/fped.2022.852073
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