Physicians' use of guidelines and attitudes to withholding and withdrawing treatment for extremely premature neonates in Norway.

OBJECTIVES

To examine if explicit written guidelines for withholding and withdrawing treatment for extremely premature infants exist and are used in obstetric and paediatric units in Norway, and to explore changes in attitudes and which factors are considered important when making decisions regarding life support.

METHODS

Cross-sectional postal survey addressed to the medical directors of all the 46 obstetric and the 28 paediatric units in Norway.

RESULTS

The response rate was 84%. Half the units had guidelines for withholding and one quarter for withdrawing life support. Most of them were non-written informal guidelines. The most important factors for withholding treatment were gestational age and vitality while risk of severe disability and future quality of life were the major concerns for withdrawing treatment. The mean reported gestational age threshold for resuscitating infants decreased from 23.6 weeks (SD +/- 0.6) in a study from 1998 to 23.0 weeks (SD +/- 0.8) in 2005 (p = 0.001). Physicians did not perceive this change in threshold, but 1/3 felt that decisions regarding provision of life support had become more difficult. Almost half of the responding physicians agreed with the statement that Norway is too liberal in its provision of life support to extremely premature infants.

CONCLUSION

The criteria for whom to provide life support or not are imprecise and may be subject to unperceived changes. Explicit local guidelines for the decision-making process may secure legitimacy and fair treatment options.