Factors influencing the attitudes of NICU physicians toward care of neonates with very poor prognosis.

Attitudes of physicians toward neonates with poor prognosis greatly influence their decisions regarding the course of treatment and care. The present study aimed to investigate factors contributing to attitudes of medical practitioners toward poor prognosis neonates. This was a cross-sectional, descriptive-analytic study. Questionnaires for assessing subjects' attitudes toward care of very poor prognosis neonates were administered to all neonatologists, pediatricians, neonatology assistants, and pediatric residents (a total of 88 individuals) working in the NICUs of Imam Khomeini Hospital. Participants' attitudes were determined through analysis of responses to seven questions on a 5-point Likert scale ranging from "strongly agree" to "strongly disagree". Presence of anomalies incompatible with an acceptable quality of life, birth weight, gestational age, responses to neonatal diagnostic tests, certain types of diseases, parental marital status and practitioner predictions about patient prognosis were the factors contributing to practitioners' attitude (P-value < 0.005). However, no significant relationship was found in connection with religious beliefs, socioeconomic status, opinions of consulting physicians, hospital treatment protocols, standards of the Association of Neonatal Physicians, and ethics committee expectations (P-value > 0.005). It can be concluded that the attitudes of practitioners toward intensive care of poor prognosis neonates is determined by the medical condition of the neonate rather than socio-demographic characteristics.

Views and Decisions of Physicians in Encountering Neonates with Poor Prognosis.

BACKGROUND: With the development of neonatal intensive care units (NICUs), new issues have emerged for physicians working in this area, including the ethical aspects of providing invasive and advanced care to neonates with extremely poor prognosis. This research was undertaken with the aim of investing the factors affecting physicians' practice in management of newborns in such complicated circumstances. METHODS: A cross-sectional study was carried out over a period of 5 months (Jan 2012 to Jun 2012) in 9 different tertiary levels and academic NICUs affiliated to Tehran University of Medical Sciences in Tehran, Iran. Checklists related to management of 3 hypothetical cases with very poor prognosis and factors affecting pertinent decisions were administered to 88 neonatologists and pediatricians. RESULTS: Totally, 81.4% of participants approved the use of advanced invasive methods of treatment in the premature neonate. Concerning the neonate with genetic malformations, 51.3% recommended advanced methods. In severe asphyxia, 42.1% disagreed with use of advanced invasive procedures. Overall, 34.2% of the target physicians approved the use of aggressive procedures in all 3 cases. Age, gender, marital status, parental status, and work experience were identified as influencing factors. CONCLUSIONS: With the prediction of acceptable levels of survivability in very premature infants, physicians are more inclined to treat this group. However, they do not favor aggressive measures in infants with severe asphyxia and advanced anomalies.