Am J Perinatol 2014; 31(06): 477-482
DOI: 10.1055/s-0033-1353440
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Physician Attitudes in Romania toward Withholding and Withdrawal of Intensive Care for Infants with Very Poor Prognosis

Edward F. Bell
1   Department of Pediatrics, University of Iowa, Iowa City, Iowa
,
Anca Roxana Bivoleanu
2   Regional Neonatal Intensive Care Unit, Department of Neonatology, Cuza-Voda Maternity Hospital, Iaşi, Romania
,
Maria Stamatin
2   Regional Neonatal Intensive Care Unit, Department of Neonatology, Cuza-Voda Maternity Hospital, Iaşi, Romania
3   Department of Neonatology, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania
,
Silvia-Maria Stoicescu
4   Department of Neonatology, Carol Davila University of Medicine and Pharmacy, Bucureşti, Romania
5   Alfred Rusescu Institute for Care of the Mother and Child, Bucureşti, Romania
› Author Affiliations
Further Information

Publication History

11 May 2013

11 July 2013

Publication Date:
21 August 2013 (online)

Abstract

Objective The purpose of this study was to examine the attitudes of Romanian physicians toward withholding and withdrawing intensive care for infants whose prognosis is very poor.

Methods A survey tool was developed by the authors and completed by participants in the annual meeting of the Neonatology Association of Romania.

Results The majority of respondents attempt resuscitation of all live-born infants, have never stopped resuscitation at birth while the infant was still alive, and have never stopped respiratory support because of poor prognosis. Nearly all respondents were uncomfortable talking with parents about withholding or withdrawing intensive care, and they were also uncomfortable talking to the parents about the death of their infant.

Conclusions Romanian physicians are uniformly reluctant to withhold or withdraw intensive care for infants, even those with very poor prognosis. In addition, physicians are very uncomfortable talking with parents about limiting or stopping support and talking about the death of an infant. Educational programs targeting the communication of difficult topics with parents have the potential to decrease the discomfort experienced by physicians in conversing with parents about their child's poor prognosis or death.

 
  • References

  • 1 Haywood JL, Goldenberg RL, Bronstein J, Nelson KG, Carlo WA. Comparison of perceived and actual rates of survival and freedom from handicap in premature infants. Am J Obstet Gynecol 1994; 171 (2) 432-439
  • 2 Haywood JL, Morse SB, Goldenberg RL, Bronstein J, Nelson KG, Carlo WA. Estimation of outcome and restriction of interventions in neonates. Pediatrics 1998; 102 (2) e20
  • 3 Morse SB, Haywood JL, Goldenberg RL, Bronstein J, Nelson KG, Carlo WA. Estimation of neonatal outcome and perinatal therapy use. Pediatrics 2000; 105 (5) 1046-1050
  • 4 Cuttini M, Nadai M, Kaminski M , et al; EURONIC Study Group. End-of-life decisions in neonatal intensive care: physicians' self-reported practices in seven European countries. Lancet 2000; 355 (9221) 2112-2118
  • 5 De Leeuw R, Cuttini M, Nadai M , et al; EURONIC study group. Treatment choices for extremely preterm infants: an international perspective. J Pediatr 2000; 137 (5) 608-616
  • 6 Rebagliato M, Cuttini M, Broggin L , et al; EURONIC Study Group (European Project on Parents' Information and Ethical Decision Making in Neonatal Intensive Care Units). Neonatal end-of-life decision making: Physicians' attitudes and relationship with self-reported practices in 10 European countries. JAMA 2000; 284 (19) 2451-2459
  • 7 Arlettaz R, Mieth D, Bucher HU, Duc G, Fauchère JC. End-of-life decisions in delivery room and neonatal intensive care unit. Acta Paediatr 2005; 94 (11) 1626-1631
  • 8 Martinez AM, Partridge JC, Yu V , et al. Physician counselling practices and decision-making for extremely preterm infants in the Pacific Rim. J Paediatr Child Health 2005; 41 (4) 209-214
  • 9 Walther FJ. Withholding treatment, withdrawing treatment, and palliative care in the neonatal intensive care unit. Early Hum Dev 2005; 81 (12) 965-972
  • 10 Cuttini M, Casotto V, Orzalesi M ; Euronic Study Group. Ethical issues in neonatal intensive care and physicians' practices: a European perspective. Acta Paediatr Suppl 2006; 95 (452) 42-46
  • 11 Verhagen AAE, van der Hoeven MAH, van Meerveld RC, Sauer PJJ. Physician medical decision-making at the end of life in newborns: insight into implementation at 2 Dutch centers. Pediatrics 2007; 120 (1) e20-e28
  • 12 Pignotti MS, Donzelli G. Perinatal care at the threshold of viability: an international comparison of practical guidelines for the treatment of extremely preterm births. Pediatrics 2008; 121 (1) e193-e198
  • 13 Cuttini M, Casotto V, de Vonderweid U, Garel M, Kollée LA, Saracci R ; EURONIC Study Group. Neonatal end-of-life decisions and bioethical perspectives. Early Hum Dev 2009; 85 (10, Suppl): S21-S25
  • 14 Kariholu U, Godambe S, Ajitsaria R , et al; North-West London Perinatal Network. Perinatal network consensus guidelines on the resuscitation of extremely preterm infants born at <27 weeks' gestation. Eur J Pediatr 2012; 171 (6) 921-926
  • 15 Bilgen H, Topuzoğlu A, Kuşçu K, Altuncu E, Özek E. End-of-life decisions in the newborn period: attitudes and practices of doctors and nurses. Turk J Pediatr 2009; 51 (3) 248-256
  • 16 McAdams RM, Erdenebileg A, Batra M, Gerelmaa Z. Attitudes of healthcare providers towards non-initiation and withdrawal of neonatal resuscitation for preterm infants in Mongolia. J Health Popul Nutr 2012; 30 (3) 346-352
  • 17 Verhagen AAE, Spijkerman J, Muskiet FD, Sauer PJ. Physician end-of-life decision-making in newborns in a less developed health care setting: insight in considerations and implementation. Acta Paediatr 2007; 96 (10) 1437-1440
  • 18 Bell EF ; American Academy of Pediatrics Committee on Fetus and Newborn. Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrics 2007; 119 (2) 401-403
  • 19 Verhagen AAE, Sauer PJJ. End-of-life decisions in newborns: an approach from The Netherlands. Pediatrics 2005; 116 (3) 736-739
  • 20 Oestergaard MZ, Inoue M, Yoshida S , et al; United Nations Inter-Agency Group for Child Mortality Estimation and the Child Health Epidemiology Reference Group. Neonatal mortality levels for 193 countries in 2009 with trends since 1990: a systematic analysis of progress, projections, and priorities. PLoS Med 2011; 8 (8) e1001080
  • 21 European Commission. Available at: http://epp.eurostat.ec.europa.eu/statistics_explained/index.php/GDP_per_capita,_consumption_per_capita_and_price_level_indices . Accessed May 11, 2013
  • 22 European Commission Heidi wiki. Available at: http://webgate.ec.europa.eu/sanco/heidi/index.php/Heidi/Population_group-specific_health/Newborns_and_perinatal_health/Infant_and_neonatal_mortality#Neonatal_mortality . Accessed May 11, 2013
  • 23 Fox S, Platt FW, White MK, Hulac P. Talking about the unthinkable: perinatal/neonatal communication issues and procedures. Clin Perinatol 2005; 32 (1) 157-170 , vii–viii
  • 24 Harrison ME, Walling A. What do we know about giving bad news? A review. Clin Pediatr (Phila) 2010; 49 (7) 619-626
  • 25 Armentrout D, Cates LA. Informing parents about the actual or impending death of their infant in a newborn intensive care unit. J Perinat Neonatal Nurs 2011; 25 (3) 261-267
  • 26 Williams C, Munson D, Zupancic J, Kirpalani H. Supporting bereaved parents: practical steps in providing compassionate perinatal and neonatal end-of-life care. A North American perspective. Semin Fetal Neonatal Med 2008; 13 (5) 335-340
  • 27 Gordijn SJ, Erwich JJHM, Khong TY. The perinatal autopsy: pertinent issues in multicultural Western Europe. Eur J Obstet Gynecol Reprod Biol 2007; 132 (1) 3-7
  • 28 Gough JK, Frydenberg AR, Donath SK, Marks MM. Simulated parents: developing paediatric trainees' skills in giving bad news. J Paediatr Child Health 2009; 45 (3) 133-138
  • 29 Vaidya VU, Greenberg LW, Patel KM, Strauss LH, Pollack MM. Teaching physicians how to break bad news: a 1-day workshop using standardized parents. Arch Pediatr Adolesc Med 1999; 153 (4) 419-422