{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T09:13:45Z","timestamp":1749546825479},"reference-count":67,"publisher":"Springer Publishing Company","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neonatal Network"],"published-print":{"date-parts":[[2000,4]]},"abstract":"<jats:p><jats:bold>Purpose:<\/jats:bold>To examine the perceptions of physicians who make delivery room decisions to resuscitate extremely low-birthweight (ELBW) neonates at marginal viability. Nurses, parents, economists, and ethicists have questioned resuscitation of ELBW neonates, many of whom experience high levels of morbidity and mortality. Yet no systematic studies were found that addressed physicians\u2019 perceptions and delivery room decisions.<\/jats:p><jats:p><jats:bold>Design:<\/jats:bold>Descriptive, using naturalistic inquiry. A national U.S. convenience sample was obtained in 1996\u20131997 of 54 physicians in five perinatal subspecialties who resuscitated ELBW neonates.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold>Tape-recorded and transcribed interviews were analyzed using NUD*IST software and line-by-line constant comparison.<\/jats:p><jats:p><jats:bold>Findings:<\/jats:bold>Despite awareness of the high morbidity and mortality, 96 percent of the physicians offered resuscitation to all ELBW neonates in the delivery room. The main factors affecting their decisions were \u201cthe role of the physician;\u201d having been \u201ctrained to save lives;\u201d the belief that \u201cif called, I resuscitate;\u201d the inability to determine gestational age; requests from parents to \u201cdo everything;\u201d and the need to move from a \u201cchaotic\u201d delivery room to a controlled neonatal intensive care unit. Six major themes were: role expectation, uncertainty, awareness, internal and external forces, burden, and continuing quandaries. Physicians were burdened by the devastated and dying babies, by their inability to predict which neonates had a chance for intact survival, and by conflicts with colleagues about viability. Statistical probability of survival, legal constraints, and cost of care did not appear to affect greatly their decisions. Physicians asked that society and national policy makers set parameters for resuscitation.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold>The American Academy of Pediatrics\u2019 Neonatal Resuscitation Protocol needs revision to delineate the ethical criteria for resuscitation. Early prenatal education for families which clearly teaches the margins of viability and outcomes of early deliveries is also recommended. Physicians must be supported in changing the resuscitation paradigm.<\/jats:p>","DOI":"10.1891\/0730-0832.19.3.25","type":"journal-article","created":{"date-parts":[[2012,5,8]],"date-time":"2012-05-08T07:45:09Z","timestamp":1336463109000},"page":"25-32","source":"Crossref","is-referenced-by-count":11,"title":["Physicians\u2019 Neonatal Resuscitation of Extremely Low-Birth-Weight Preterm Infants"],"prefix":"10.1891","volume":"19","author":[{"given":"Anita","family":"Joy Catlin","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"793","published-online":{"date-parts":[[2000,4,1]]},"reference":[{"key":"1","doi-asserted-by":"crossref","first-page":"176","DOI":"10.2307\/1602514","article-title":"Long term developmental outcomes of low birth weight infants","volume":"5","author":"A Goldworth","year":"1995","journal-title":"The Future of Children"},{"key":"2","article-title":"Cost of care for a geographically determined population of low birthweight infants to age 8\u20139 years. 1. Children without disability","volume":"74","author":"RC Stevenson","year":"1996","journal-title":"Archives of Disease in Childhood"},{"key":"3","doi-asserted-by":"crossref","DOI":"10.1525\/9780520353787","volume-title":"Deciding Who Lives: Fateful Choices in the Intensive-Care Nursery","author":"RR. Anspach","year":"1993"},{"issue":"2","key":"4","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/S0029-6465(22)02597-X","article-title":"Defining futility in neonatal intensive care","volume":"33","author":"JH. Penticuff","year":"1998","journal-title":"Nursing Clinics of North America"},{"key":"5","doi-asserted-by":"crossref","first-page":"909","DOI":"10.2105\/AJPH.85.7.909","article-title":"Neonatal technology, perinatal survival, social consequences, and the perinatal paradox","volume":"85","author":"RM. Kliegman","year":"1995","journal-title":"American Journal of Public Health"},{"key":"6","volume-title":"The Very Low Birthweight Infant","author":"WA. Silverman","year":"1990"},{"key":"7","doi-asserted-by":"crossref","first-page":"971","DOI":"10.1542\/peds.90.6.971","article-title":"Overtreatment of neonates? A personal retrospective","volume":"90","author":"WA. Silverman","year":"1992","journal-title":"Pediatrics"},{"issue":"1","key":"8","first-page":"23","article-title":"Attitudes\/beliefs\/feelings held by neonatal nurses toward the care and management of fetal-infants","volume":"5","author":"D. Armentrout","year":"1986","journal-title":"Neonatal Network"},{"issue":"1","key":"9","first-page":"41","article-title":"Dying babies and associated stress in NICU nurses","volume":"14","author":"V Downey","year":"1995","journal-title":"Neonatal Network"},{"key":"10","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1086\/JCE199102409","article-title":"Ethical issues described by NICU nurses","volume":"2","author":"PA Miya","year":"1991","journal-title":"Journal of Clinical Ethics"},{"key":"11","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/S0882-5963(05)80065-X","article-title":"Family responses to childhood chronic illness: Description of management styles","volume":"11","author":"K Knafl","year":"1996","journal-title":"Journal of Pediatric Nursing"},{"key":"12","volume-title":"Lost Lullaby","author":"DG. Alecson","year":"1995"},{"key":"13","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1111\/j.1365-2648.1989.tb01638.x","article-title":"Managing chronic illness in the family: Women as caretakers","volume":"14","author":"JM Anderson","year":"1989","journal-title":"Journal of Advanced Nursing"},{"key":"14","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1111\/j.1523-536X.1992.tb00677.x","article-title":"Medical miracle or pyrrhic victory?","volume":"19","author":"H. Harrison","year":"1992","journal-title":"Birth"},{"key":"15","unstructured":"Jennings M. 1994. A mother talks to Mrs. Clinton. <i>Wall Street Journal<\/i> January 3: 6."},{"key":"16","first-page":"418","article-title":"Realities of a premature infant's first year: Helping parents cope","volume":"15","author":"DJ. Maroney","year":"1995","journal-title":"Journal of Perinatology"},{"key":"17","volume-title":"Silvie's Life","author":"M. Rogoff","year":"1995"},{"key":"18","volume-title":"The Long Dying of Baby Andrew","author":"R Stinson","year":"1983"},{"issue":"2 part 2","key":"19","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/S0196-0644(05)80484-6","article-title":"Ethical issues in pediatric and neonatal resuscitation","volume":"22","author":"J. Landwirth","year":"1993","journal-title":"Annals of Emergency Medicine"},{"key":"20","first-page":"494","article-title":"Perceptions of the limit of viability: Neonatologists attitudes toward extremely preterm infants","volume":"15","author":"MR Sanders","year":"1995","journal-title":"Journal of Perinatology"},{"key":"21","unstructured":"United States Department of Health and Human Services. 1998. Births and deaths: Preliminary data for 1997. Centers for Disease Control, National Center for Health Statistics, National Vital Statistics Report, 47(4): 3."},{"key":"22","doi-asserted-by":"crossref","first-page":"14","DOI":"10.2307\/1602504","article-title":"Low birth weight: Analysis and recommendations","volume":"5","author":"PH Shiono","year":"1995","journal-title":"The Future of Children"},{"key":"23","volume-title":"Neonatal Resuscitation","author":"RS Bloom","year":"1994"},{"key":"24","unstructured":"Cummins RO (ed.). 1994. <i>Advanced Cardiac Life Support.<\/i> Dallas, Texas: American Academy of Pediatrics and American Heart Association."},{"key":"25","volume-title":"Pediatric Advanced Life Support","author":"L Chameides","year":"1994"},{"key":"26","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics Committee of Fetus and Newborn. 1995. Perinatal care at the threshold of viability. <i>Pediatrics<\/i> 96: 974\u2013976.","DOI":"10.1542\/peds.96.5.974"},{"key":"27","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1542\/pir.18-3-99","article-title":"Prognosis of low birthweight babies","volume":"18","author":"D. Campbell","year":"1997","journal-title":"Pediatrics in Review"},{"issue":"1","key":"28","doi-asserted-by":"crossref","first-page":"176","DOI":"10.2307\/1602514","article-title":"Longterm developmental outcomes of low birthweight infants","volume":"5","author":"M Hack","year":"1995","journal-title":"The Future of Children"},{"key":"29","first-page":"479","article-title":"Outcome of infants weighing less than 800 grams at birth: 15 years experience","volume":"96","author":"TR La Pine","year":"1995","journal-title":"Pediatrics"},{"key":"30","article-title":"Perinatal management at the lower margin of viability","volume":"74","author":"JM. Rennie","year":"1996","journal-title":"Archives of Disease in Childhood"},{"issue":"1","key":"31","first-page":"18","article-title":"Neurodevelopmental outcome of extremely low birth weight infants in Maryland","volume":"46","author":"RK Blitz","year":"1997","journal-title":"Maryland Medical Journal"},{"key":"32","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/S0033-3506(96)80105-3","article-title":"Neurodevelopmental outcome at age two years amongst very low birth weight infants: Results from a district general hospital","volume":"110","author":"VD Sethi","year":"1996","journal-title":"Public Health"},{"key":"33","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1001\/archpedi.1996.02170330016003","article-title":"Extremely low birth weight children and their peers","volume":"150","author":"CL Halsey","year":"1996","journal-title":"Archives of Pediatric Adolescent Medicine"},{"key":"34","article-title":"Neurological signs and perceptual motor difficulties in prematurely born children","volume":"76","author":"M Jongmans","year":"1997","journal-title":"Archives of Disease in Childhood"},{"issue":"11","key":"35","article-title":"Rehospitalization of very low birth weight infants after discharge from neonatal intensive care units","volume":"128","author":"B Bar Oz","year":"1995","journal-title":"Harefuah"},{"key":"36","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1097\/00004703-199512000-00002","article-title":"Admission to a neonatal care unit as a predictor of long term health: A 12 year follow-up","volume":"16","author":"KN Speechley","year":"1995","journal-title":"Developmental and Behavioral Pediatrics"},{"key":"37","article-title":"Academic achievement and educational resource use of very low birth weight (VLBW) survivors","volume":"23","author":"BD Schraeder","year":"1997","journal-title":"Pediatric Nursing"},{"key":"38","unstructured":"Fetus and Newborn Committee, Canadian Paediatric Society. 1994. Management of the woman with threatened birth of an infant of extremely low gestational age. <i>Canadian Medical Association Journal<\/i> 151: 547\u2013553."},{"key":"39","first-page":"473","article-title":"From how small is too small to how much is too much?","volume":"23","author":"JL Peabody","year":"1996","journal-title":"Clinics in Perinatology"},{"key":"40","first-page":"144","article-title":"Neonatologists and bioethics after Baby Doe","volume":"13","author":"BS. Carter","year":"1993","journal-title":"Journal of Perinatology"},{"key":"41","doi-asserted-by":"crossref","first-page":"677","DOI":"10.1056\/NEJM198803173181105","article-title":"Neonatologists judge the \"Baby Doe\" regulations","volume":"318","author":"LM Kopelman","year":"1988","journal-title":"New England Journal of Medicine"},{"key":"42","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1007\/978-1-4612-5000-5_12","article-title":"Consensus and controversy in the treatment of catastrophically ill newborns","volume-title":"Which Babies Shall Live?","author":"BW. Levin","year":"1985"},{"key":"43","first-page":"232","article-title":"Changing attitudes of neonatologists toward ventilator support","volume":"8","author":"JJ Pomerance","year":"1988","journal-title":"Journal of Perinatology"},{"key":"44","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1542\/peds.81.5.643","article-title":"Life-saving therapy for newborns: A questionnaire survey in the state of Massachusetts","volume":"81","author":"ID Todres","year":"1988","journal-title":"Pediatrics"},{"issue":"92","key":"45","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1007\/BF02600206","article-title":"The discussion of end-of-life medical care by primary care patients and physicians","author":"MP Pfeifer","year":"1994","journal-title":"Journal of General Internal Medicine"},{"key":"46","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1111\/j.1748-720X.1994.tb01313.x","article-title":"Doing all they can: Physicians who deny medical futility","volume":"22","author":"JW Swanson","year":"1994","journal-title":"The Journal of Law, Medicine, and Ethics"},{"key":"47","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1542\/peds.92.3.447","article-title":"How aggressive should delivery room cardiopulmonary resuscitation be for extremely low birth weight neonates?","volume":"92","author":"DJ. Davis","year":"1993","journal-title":"Pediatrics"},{"key":"48","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1056\/NEJM198801143180206","article-title":"Survival after cardiopulmonary resuscitation in babies of very low birth weight: Is CPR futile therapy?","volume":"38","author":"JD Lantos","year":"1988","journal-title":"New England Journal of Medicine"},{"issue":"3 part 2","key":"49","article-title":"Very difficult questions in neonatal resuscitation","volume":"5","author":"J. Kattwinkel","year":"1996","journal-title":"NRP Instructor Update"},{"issue":"2","key":"50","doi-asserted-by":"crossref","first-page":"32","DOI":"10.2307\/3562922","article-title":"The sorcerer's broom: Medicine's rampant technology","volume":"23","author":"EJ. Cassell","year":"1993","journal-title":"Hastings Center Report"},{"issue":"5","key":"51","doi-asserted-by":"crossref","first-page":"9","DOI":"10.2307\/3562663","article-title":"In death's shadow: The meanings of withholding resuscitation","volume":"17","author":"K. Nolan","year":"1987","journal-title":"Hastings Center Report"},{"key":"52","volume-title":"Doing Naturalistic Inquiry","author":"DA Erlandson","year":"1993"},{"key":"53","volume-title":"Symbolic Interactionism: An Introduction, An Interpretation, An Integration","author":"JM. Charon","year":"1979"},{"key":"54","volume-title":"The Discovery of Grounded Theory: Strategies for Qualitative Research","author":"BG Glaser","year":"1967"},{"key":"55","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1177\/000992288502400102","article-title":"Follow-up of families in whom life support was withdrawn","volume":"24","author":"E Walwork","year":"1985","journal-title":"Clinical Pediatrics"},{"key":"56","article-title":"Withdrawal of neonatal intensive care in the home","volume":"71","author":"JM Hawdon","year":"1994","journal-title":"Archives of Diseases in Childhood"},{"key":"57","first-page":"314","article-title":"Induced early delivery of a fetus with hypoplastic left heart: A moral choice when neither surgery nor abortion is an acceptable option","volume":"17","author":"JJ Paris","year":"1997","journal-title":"Journal of Perinatology"},{"key":"58","first-page":"178","article-title":"Family centered care and the anticipated death of a newborn","volume":"23","author":"L. Pearson","year":"1997","journal-title":"Pediatric Nursing"},{"issue":"3","key":"59","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1177\/082585979601200308","article-title":"Ethical aspects of pediatric palliative care","volume":"12","author":"M. Levetown","year":"1996","journal-title":"Journal of Palliative Care"},{"key":"60","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1097\/00003246-199305000-00023","article-title":"Pediatric intensive care training: Confronting the dark side","volume":"21","author":"MS Jellinck","year":"1993","journal-title":"Critical Care Medicine"},{"key":"61","unstructured":"ECHO Committee on Neonatology. 1997. <i>Guidelines for Neonatology.<\/i> Sacramento Health Care Decisions. 4747 Engle Road. Carmichael, California, 95608."},{"key":"62","unstructured":"WAPC-Wisconsin Association for Perinatal Care. 1997. Position statement: Guidelines for the responsible utilization of neonatal intensive care. Wisconsin Association for Perinatal Care. McConnell Hall, 1010 Mound Street, Madison, Wisconsin, 53715."},{"key":"63","unstructured":"United States Department of Health and Human Services. 1989. Caring for our future: The content of prenatal care: Report from expert panel. U.S. Department of Health and Human Services, Public Health Services, National Institutes of Health, NIH Publication No. 90-3182, Washington, DC: United States Department of Health and Human Services."},{"key":"64","first-page":"214","article-title":"Dubious distentions between research and clinical practice using experimental therapies","volume-title":"Ethics and Perinatology","author":"J. Tyson","year":"1995"},{"key":"65","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/S0025-6196(12)61527-4","article-title":"Ethical dilemmas in the neonatal intensive care unit","volume":"62","author":"CL. Berseth","year":"1987","journal-title":"Mayo Clinic Proceedings"},{"key":"66","doi-asserted-by":"crossref","DOI":"10.1007\/978-0-585-27589-5_8","article-title":"Physicians and technological change","author":"RM. Cook-Deegan","year":"1988","journal-title":"The Physician as Captain of the Ship: A Critical Reappraisal"},{"key":"67","article-title":"Moral and ethical dilemmas in special care nurseries","volume":"289","author":"RS Duff","year":"1973","journal-title":"New England Journal of Medicine"}],"container-title":["Neonatal Network"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1891\/0730-0832.19.3.25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T09:29:07Z","timestamp":1713950947000},"score":1,"resource":{"primary":{"URL":"http:\/\/connect.springerpub.com\/lookup\/doi\/10.1891\/0730-0832.19.3.25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,4]]},"references-count":67,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2000,4,1]]},"published-print":{"date-parts":[[2000,4]]}},"alternative-id":["10.1891\/0730-0832.19.3.25"],"URL":"https:\/\/doi.org\/10.1891\/0730-0832.19.3.25","relation":{},"ISSN":["0730-0832","1539-2880"],"issn-type":[{"value":"0730-0832","type":"print"},{"value":"1539-2880","type":"electronic"}],"subject":[],"published":{"date-parts":[[2000,4]]}}}