THE TREATMENT OF NON-HIV-RELATED CONDITIONS IN NEWBORNS AT RISK FOR HIV - A SURVEY OF NEONATOLOGISTS

Objectives. The purpose of this study was to examine attitudes of neon atologists about treatment of conditions unrelated to the human immuno deficiency virus (HIV) for critically ill newborns at risk for HIV. Me thods. Questionnaires were mailed to the 1508 members of the Section o n Perinatal Medicine of the American Academy of Pediatrics; 63% comple ted the survey (n = 951). The survey included structured questions abo ut treatment for hypothetical cases and open-ended questions eliciting reasons for decisions. Results. Differences in recommendations for tr eatment by both maternal and infant HIV status were substantial and st atistically reliable. For example, 98% of respondents recommended life -saving cardiac surgery for a neonate with no risk for HIV, but only 9 3% recommended such surgery for a child of an HIV-positive mother; onl y 50% recommended the same surgery for a newborn known to be infected. The corresponding figures for chronic dialysis were 91%, 61%, and 26% . Most expected diminished quality of life for both infected and uninf ected children of HIV-positive mothers. Conclusion. Recommendations ab out life-sustaining treatment for non-HIV-related conditions varied by HIV status. These data on physician attitudes raise the possibility t hat infants labeled as HIV positive, whether infected or not, may suff er discrimination.