Survival at the threshold of viability: a nationwide survey of the opinions and attitudes of physicians in a developing country

Paediatr Perinat Epidemiol. 2014 May;28(3):227-34. doi: 10.1111/ppe.12118. Epub 2014 Mar 21.


Background: To explore physicians' opinions and attitudes regarding resuscitation of extremely premature infants (EPIs) in a developing country with suboptimal resources.

Methods: A survey was developed, revised, and pilot-tested. All 964 paediatricians registered in the Lebanese Order of Physicians were contacted; physicians involved in resuscitation of EPIs were eligible. Between February and April of 2009, anonymous surveys were mailed to consenting participants.

Results: Three hundred twenty-eight eligible physicians agreed to participate. One hundred twenty (36%) returned the survey, 45.3% of which were neonatologists. The vast majority agreed that parents would like to be informed and to participate in the resuscitation decision of an EPI. The majority of physicians considered infants at gestational age of ≤25 weeks (78%) or ≤800 g (89%) as non-viable. Physician's age, years of practice, and practising neonatal intensive care unit level were significantly associated with the choice of birthweight at which infants were considered non-viable.

Conclusions: The majority of surveyed physicians consider infants at gestational age less than or equal to 25 weeks gestation or 800 g at birth as non-viable, and therefore would not attempt their resuscitation. Factors influencing threshold of viability in developing countries need to be addressed and explored further.

Keywords: developing countries; end of life ethics; extremely premature infant; middle income country; physician attitude; resuscitation decision; threshold of viability.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attitude of Health Personnel
  • Decision Making
  • Female
  • Fetal Viability*
  • Gestational Age
  • Health Care Surveys
  • Humans
  • Infant, Extremely Low Birth Weight*
  • Infant, Newborn
  • Informed Consent* / ethics
  • Intensive Care Units, Neonatal* / ethics
  • Intensive Care Units, Neonatal* / statistics & numerical data
  • Lebanon
  • Male
  • Parents*
  • Physician's Role
  • Pilot Projects
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'
  • Pregnancy
  • Resuscitation* / ethics
  • Resuscitation* / statistics & numerical data