ArticleBMC medical ethics2021
Neonatologists' decision-making for resuscitation and non-resuscitation of extremely preterm infants: ethical principles, challenges, and strategies-a qualitative study.
Article in BMC medical ethics, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Physicians' attitudes and experiences about withholding/withdrawing life-sustaining treatments in pediatrics: a systematic review of quantitative evidence.BMC palliative care · 2023Pooled it
- Third-Party Consent To Medical Treatment in Malaysia: A Critical Analysis from Ethical and Malaysian Legal Perspectives.Health care analysis : HCA : journal of health philosophy and policy · 2026Article
- Ethical challenges and moral conflicts in periviability prenatal counseling: a scoping review of healthcare professionals' perspectives.BMC medical ethics · 2026Article
- Barriers to and Facilitators of Pediatric Palliative Care in Mainland China, Hong Kong, and Taiwan: A Document Analysis.Children (Basel, Switzerland) · 2025Article
- Positioning comfort measures in antenatal counselling for periviable infants.Sociology of health & illness · 2025Article
- Doctor-Parent Disagreement for Preterm Infants Born in the Grey Zone: Do Ethical Frameworks Help?Journal of bioethical inquiry · 2024Article
- Addressing the gap in preterm resuscitation practices in high-income and low-middle income countries: a multicenter survey of the Asian neonatal network collaboration.Frontiers in pediatrics · 2024Article
- The use of projected autonomy in antenatal shared decision-making for periviable neonates: a qualitative study.Maternal health, neonatology and perinatology · 2023Article
- Special Issue: Intensive Care for Critically Ill Neonates: Clinical Diagnosis and Treatment.Children (Basel, Switzerland) · 2023Article
- Moral distress among neonatologists working in neonatal intensive care units in Greece: a qualitative study.BMC pediatrics · 2023Article
- Differences in the attitudes towards resuscitation of extremely premature infants between neonatologists and obstetricians: a survey study in China.Frontiers in pediatrics · 2023Article
- Guidelines for Cancer Treatment during Pregnancy: Ethics-Related Content Evolution and Implications for Clinicians.Cancers · 2022Review
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundDeciding whether to resuscitate extremely preterm infants (EPIs) is clinically and ethically problematic. The aim of the study was to understand neonatologists' clinical-ethical decision-making for resuscitation of EPIs.
methodsWe conducted a qualitative study in Belgium, following a constructivist account of the Grounded Theory. We conducted 20 in-depth, face-to-face, semi-structured interviews with neonatologists. Data analysis followed the qualitative analysis guide of Leuven.
resultsThe main principles guiding participants' decision-making were EPIs' best interest and respect for parents' autonomy. Participants agreed that justice as resource allocation should not be considered in resuscitation decision-making. The main ethical challenge for participants was dealing with the conflict between EPIs' best interest and respect for parents' autonomy. This conflict was most prominent when parents and clinicians disagreed about births within the gray zone (24-25 weeks). Participants' coping strategies included setting limits on extent of EPI care provided and rigidly following established guidelines. However, these strategies were not always feasible or successful. Although rare, these situations often led to long-lasting moral distress.
conclusionsParticipants' clinical-ethical reasoning for resuscitation of EPIs can be mainly characterized as an attempt to balance EPIs' best interest and respect for parents' autonomy. This approach could explain why neonatologists considered conflicts between these principles as their main ethical challenge and why lack of resolution increases the risk of moral distress. Therefore, more research is needed to better understand moral distress in EPI resuscitation decisions. CLINICAL
trial registrationThe study received ethical approval from the ethics committee of UZ/KU Leuven (S62867). Confidentiality of personal information and anonymity was guaranteed in accordance with the General Data Protection Regulation of 25 May 2018.
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