Resuscitation of Likely Nonviable Newborns: Would Neonatology Practices in California Change if the Born-Alive Infants Protection Act Were Enforced?
| Autor: | J. Colin Partridge, Alma M Martinez, Mya D. Sendowski, Eleanor A. Drey |
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| Rok vydání: | 2009 |
| Předmět: |
Adult
Male Health Knowledge Attitudes Practice medicine.medical_specialty Pediatrics Resuscitation Legislation Medical Palliative care Attitude of Health Personnel Gestational Age Legislation California Law Enforcement medicine Civil Rights Humans Neonatology Practice Patterns Physicians' Resuscitation Orders business.industry Infant Care Public health Infant Newborn Law enforcement Middle Aged Prognosis Health Care Surveys Family medicine Pediatrics Perinatology and Child Health Female business End-of-life care Infant Premature |
| Zdroj: | Pediatrics. 123:1088-1094 |
| ISSN: | 1098-4275 0031-4005 |
| DOI: | 10.1542/peds.2008-0643 |
| Popis: | BACKGROUND. The effects of the Born-Alive Infants Protection Act of 2002, which defines the legal status of live-born infants have not been evaluated. OBJECTIVE. To study neonatologists' perceptions and the potential effects of the Born-Alive Infants Protection Act and subsequent Department of Health and Human Services enforcement guidelines on resuscitation and comfort care for infants born at 20 to 24 weeks' gestation. METHODS. From August 2005 to November 2005, we mailed surveys to all 354 neonatologists practicing in California. Surveys asked physicians to characterize their knowledge of and attitudes toward this legislation and enforcement guidelines, current resuscitation and comfort-care practices for extreme prematurity, anticipated changes in practice were the enforced, and demographic information. We hypothesized that enforcement would alter thresholds for resuscitation and care. RESULTS. We obtained 156 completed surveys (response rate: 44%); 140 fulfilled criteria for analysis. More than half of the neonatologists had not heard of this Act or the enforcement guidelines. Screening examinations at birth were infrequent (90%) criticized the legislation; only 6% felt that it should be enforced. If it were enforced, physicians predicted that they would lower birth weight and gestational age thresholds for resuscitation and comfort care. CONCLUSIONS. The Born-Alive Infants Protection Act clarified the legal status of “born-alive” infants, but enforcement guidelines fail to clarify what measures are appropriate when survival is unlikely. The Act may constrain resuscitation options offered to parents, because neonatologists anticipate medicolegal threats if they pursue nonintervention. If this legislation were enforced, respondents predicted more aggressive resuscitation potentially increasing risks of disability or delayed death. Until outcomes for infants of |
| Databáze: | OpenAIRE |
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