Trial of Therapy on Trial: Inconsistent Thresholds for Discussing Withdrawal of Life-Sustaining Therapies in the Neonatal Intensive Care Unit

Am J Perinatol. 2024 May;41(S 01):e794-e802. doi: 10.1055/a-1941-4285. Epub 2022 Sep 12.

Abstract

Objective: This study aimed to establish the degree of variability in thresholds for discussing withdrawal of life-sustaining therapies (WLST) in periviable infants among neonatal intensive care unit (NICU) personnel.

Study design: A vignette-style survey was administered to NICU personnel at two urban NICUs assessing likelihood of discussing WLST or support for discussing WLST (on a scale from 1, not at all likely/supportive to 10, extremely likely/supportive) in 10 clinical scenarios.

Results: Response rates ranged by clinical role from 26 to 89%. Participant responses ranged from 1 to 10 in 5 out of 10 vignettes for NICU attendings, and 9 out of 10 vignettes for bedside nurses. Lower gestational age (22-23 vs. 24-25 weeks) was associated with increased likelihood to discuss WLST in some but not all scenarios.

Conclusion: NICU personnel have widely variable criteria for discussing WLST which threatens the informed consent process surrounding resuscitation decisions in a "trial of therapy" framework.

Key points: · NICU personnel have variable criteria for WLST.. · Parents have little say in whether WLST is offered.. · Disclosure of variable criteria is not routine..

MeSH terms

  • Adult
  • Attitude of Health Personnel
  • Decision Making
  • Female
  • Gestational Age
  • Humans
  • Infant, Extremely Premature
  • Infant, Newborn
  • Informed Consent
  • Intensive Care Units, Neonatal*
  • Life Support Care
  • Male
  • Parents / psychology
  • Resuscitation Orders / ethics
  • Surveys and Questionnaires
  • Withholding Treatment*