Survey of neonatologists’ attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit

Objective: To understand neonatologists’ attitudes toward end-of-life (EOL) management in clinical scenarios, EOL ethical concepts and resource utilization. Study Design: American Academy of Pediatrics (AAP) Perinatal section members completed an anonymous online survey. Respondents indicated preferences in limiting life-sustaining treatments in four clinical scenarios, ranked agreement with EOL-care ethics statements, indicated outside resources previously used and provided demographic information. Result: In all, 451 surveys were analyzed. Across clinical scenarios and as general ethical concepts, withdrawal of mechanical ventilation in severely affected patients was most accepted by respondents; withdrawal of artificial nutrition and hydration was least accepted. One-third of neonatologists did not agree that non-initiation of treatment is ethically equivalent to withdrawal. Around 20% of neonatologists would not defer care if uncomfortable with a parent's request. Respondents’ resources included ethics committees, AAP guidelines and legal counsel/courts. Conclusion: Challenges to providing just, unified EOL care strategies are discussed, including deferring care, limiting artificial nutrition/hydration and conditions surrounding ventilator withdrawal.