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Journal of Tropical Pediatrics Advance Access published online on December 15, 2004
Journal of Tropical Pediatrics, doi:10.1093/tropej/fmh066
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Journal of Tropical Pediatrics, Vol. 0, No. 0 © Oxford University Press 2005; all rights reserved.

Article

Intensive Care for Very Low Birthweight Infants in South Africa: A Survey of Physician Attitudes, Parent Counseling and Resuscitation Practices

J. Colin Partridge 1*, Tushar M. Ranchod 1, Daynia E. Ballot 2, Alma M. Martinez 1, Barbara J. Cory 2, and Victor A. Davies 2

1 University of California San Francisco, Department of Pediatrics, San Francisco General Hospital, California, USA
2 University of Witwatersrand, Department of Paediatrics, Johannesburg General Hospital, Johannesburg, Gauteng, South Africa

* To whom correspondence should be addressed.
J. Colin Partridge, E-mail: cpartridge{at}sfghpeds.ucsf.edu


  Abstract

Improving outcomes have promoted utilization of intensive care for premature infants in developing countries with available fiscal and technological resources. Physician counseling and decision-making have not been characterized where economic restrictions, governmental guidelines, and physician cultural attitudes may influence decisions about the appropriateness of neonatal intensive care. A cross-sectional survey of all neonatologists and pediatricians providing neonatal care in public and private hospitals in South Africa (n = 394) was carried out. Physicians returned 93 surveys (24 per cent response rate). Frequency of counseling increased with increasing gestational age (GA) but was not universally provided at any GA. Morbidity and mortality were consistently discussed and fiscal considerations frequently discussed when antenatal counseling occurred. Resuscitation thresholds were 25-26 weeks and 665-685 g, and were higher in public than in private hospitals. Decisions to limit resuscitation were based more on expected outcome than on patients' wishes or economics. At 24-25 weeks, 91 per cent of physicians would not resuscitate despite parents' wishes; 93 per cent of physicians would resuscitate 28-29-week-old infants over parents' refusal. Parents expecting premature infants are not invariably counseled. In making life-support decisions, physicians consider infants' best interests and, less frequently, financial and emotional burdens. Thresholds for resuscitation and intensive care are higher in public hospitals, and higher than in developed countries. Physicians relegate parents to a passive role in life-support decisions.


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J. C. Partridge, A. M. Martinez, H. Nishida, N.-Y. Boo, K. W. Tan, C.-Y. Yeung, J.-H. Lu, and V. Y.H. Yu
International Comparison of Care for Very Low Birth Weight Infants: Parents' Perceptions of Counseling and Decision-Making
Pediatrics, August 1, 2005; 116(2): e263 - e271.
[Abstract] [Full Text] [PDF]


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