End-of-Life Decisions 20 Years after EURONIC: Neonatologists’ Self-Reported Practices, Attitudes, and Treatment Choices in Germany, Switzerland, and Austria - 14/02/19

Doi : 10.1016/j.jpeds.2018.12.064

Katja Schneider, MD ^1,^⁎ , Boris Metze, BSc ², Christoph Bührer, MD, PhD ², Marina Cuttini, MD, PhD ³, Lars Garten, MD ²
¹ Department of Neonatology, GFO Kliniken Bonn, Bonn, Germany
² Department of Neonatology, Charité-Universitätsmedizin Berlin, Berlin, Germany
³ Clinical Care and Management Innovation Research Area, Ospedale Pediatrico Bambino Gesù, Rome, Italy

^∗Reprint requests: Katja Schneider, MD, GFO Kliniken Bonn, Abteilung für Neonatologie Robert-Koch-Straße 1, 53115 Bonn, Germany.GFO Kliniken BonnAbteilung für Neonatologie Robert-Koch-Straße 1Bonn53115Germany

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 14 February 2019

Abstract

Objective

To assess changes in attitudes of neonatologists regarding the care of extremely preterm infants and parental involvement over the last 20 years.

Study design

Internet-based survey (2016) involving 170 tertiary neonatal intensive care units in Austria, Switzerland, and Germany using the European Project on Parents' Information and Ethical Decision Making in Neonatal Intensive Care Units questionnaire (German edition) with minor modifications to the original survey from 1996 to 1997.

Results

The 2016 survey included 104 respondents (52.5% response rate). In 2016, significantly more neonatologists reported having ever withheld intensive care treatment (99% vs 69%) and withdrawn mechanical ventilation (96% vs 61%) or life-saving drugs (99% vs 79%), compared with neonatologists surveyed in 1996-1997. Fewer considered limiting intensive care as a slippery slope possibly leading to abuse (18% vs 48%). In the situation of a deteriorating clinical condition despite all treatment, significantly more neonatologists would ask parental opinion about continuation of intensive care (49% vs 18%). In 2016, 21% of German neonatologists would resuscitate a hypothetical infant at the limits of viability, even against parental wishes.

Conclusions

Withholding or withdrawing intensive care for extremely preterm infants at the limits of viability with parental involvement has become more acceptable than it was 20 years ago. However, resuscitating extremely preterm infants against parental wishes remains an option for up to one-fifth of the responding neonatologists in this survey.

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Keywords : withholding and withdrawing, quality of life, parental involvement, extremely low birth weight, limits of viability

Abbreviations : EURONIC, NICU

Plan

End-of-life Decisions in Neonatal Intensive Care: Physicians' Self-Reported Practices

Ethical Decision Making: Physicians' Self-Reported Attitudes

Birth at the Limits of Viability: Physicians' Attitudes Toward a Paradigmatic Clinical Case

Discussion

Supported by the Buchwald-Stiftung (Berlin, Germany) and the BIH-Charité Clinical Fellows Program funded by the Charité-Universitätsmedizin Berlin and the Berlin Institute of Health. The authors declare no conflicts of interest.