Babies born at the threshold of viability: attitudes of paediatric consultants and trainees in South East England

Acta Paediatr. 2011 Jan;100(1):42-6. doi: 10.1111/j.1651-2227.2010.01975.x. Epub 2010 Sep 27.


Aim: To determine attitudes of paediatric consultants and trainees towards immediate care of babies born at 22-24 weeks gestation.

Methods: A questionnaire was sent to one consultant and one trainee within each of 63 neonatal units in South East England.

Results: Response rate was 90% (111/123). At 22 weeks gestation, 51% of all respondents would not attend the delivery. At 23 weeks gestation, 63% of respondents would advise against resuscitation during antenatal counselling but 45% would resuscitate despite a parental request for comfort care. Forty-one percent of respondents would provide comfort care for a 23 week gestation baby born in poor condition. If required, 53% of respondents would use chest compressions and/or adrenaline at birth of a 24 week gestation infant (38% consultants, 54% trainees; p = 0.05). More experienced and older paediatricians were more likely to attend 22 week deliveries and be comfortable with parental requests for resuscitation. Fifty-four percent of units had written guidelines on care of these babies. Significantly more consultants (67%) than trainees (25%) correctly classified neonatal deaths.

Conclusions: Paediatricians with greater experience and age demonstrated more shared decision-making with parents. Nearly half of paediatricians would defy parental wishes at 23 weeks gestation, contrary to ethical recommendations (Nuffield Council on Bioethics,

MeSH terms

  • Age Factors
  • Attitude of Health Personnel*
  • Clinical Competence
  • Dissent and Disputes*
  • England
  • Fetal Viability*
  • Gestational Age
  • Health Care Surveys
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Pediatrics*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Professional-Family Relations*
  • Resuscitation Orders
  • Surveys and Questionnaires
  • Time Factors