Attitudes of neonatal clinicians towards resuscitation of the extremely premature infant: An exploratory survey

Objective: This study aims to explore the current attitudes of Australian n eonatologists and nurses towards the resuscitation of extremely preterm inf ants. Methodology: An anonymous questionnaire regarding resuscitation of infants of less than 28 weeks gestation was sent to all neonatologists and three re gistered nurses in each perinatal centre in Australia. Results: One hundred and thirty-three questionnaires were sent. A return ra te of 93% and 73% was obtained from neonatologists and nurses, respectively . Twenty-two per cent of neonatologists would 'occasionally' resuscitate at 22 weeks while none of the nurses would. A considerable proportion of neon atologists (23%) but only a few nurses (6%) would 'quite often' resuscitate 23-week infants. The majority of neonatologists (85%) and nurses (88%) wou ld 'almost always' resuscitate 24 week infants. More than half of the respo ndents would 'occasionally' resuscitate a 400-499 g infant and most would r esuscitate infants weighing more than 500 g. Clinicians were not as optimis tic of long-term outcome as they were for survival. Typically, only 52% of neonatologists and 38% of nurses thought babies of 25 weeks gestation had a greater than 50% chance of survival without major handicap. Parental wishe s and the presence of congenital abnormalities were major influences on dec ision to resuscitate. Hypothetically, most respondents, more doctors than n urses, would consider initiating resuscitation without parental consent at a median gestation of 25 weeks. Conclusions: The majority of Australian clinicians would resuscitate at a g estation of 24 weeks or greater or at a birth weight of over 500 g despite conservative estimates of intact survival. This survey has brought to light the importance of communication with parents prior to extreme premature bi rth.