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Relationship between site of training and residents' attitudes about neonatal resuscitation.

Janvier A, Barrington K, Deschênes M, Couture E, Nadeau S, Lantos J

McGill University, Department of Pediatrics, Montreal, Quebec, Canada.

OBJECTIVE: To determine whether the attitudes of pediatric and obstetric residents concerning the resuscitation of extremely preterm infants, and their knowledge of outcomes, varies according to their center of training and its resuscitation practices. DESIGN: Anonymous questionnaire. SETTING: Four province of Quebec, Canada, university centers. PARTICIPANTS: A total of 165 pediatric and obstetric residents. INTERVENTIONS: Survey of attitudes about resuscitation of neonates born between 23 and 27 weeks of gestation, and knowledge of the prevalence of cerebral palsy in survivors. MAIN OUTCOME MEASURES: Proportion of residents who would resuscitate a depressed, very preterm infant, and the proportion who overestimated the prevalence of cerebral palsy. RESULTS: The percentage of residents who would resuscitate a depressed infant born at 24 weeks varied from 11% to 39% between centers, at 25 weeks between 26% and 69%, and at 26 weeks between 51% and 86%. At the center most likely to intervene for very immature infants, the greatest proportion of residents favored resuscitation at each gestational age. At the least interventionist center, the smallest proportion would resuscitate. The center of training was the only factor related to willingness to resuscitate at 24, 25, 26, and 27 weeks of gestation; not age, years of training, religion, sex, or parental status (whether the person surveyed has children). A total of 53% of residents thought the prevalence of cerebral palsy was 25% or 40% in this population. Residents with a more accurate knowledge of outcome were more likely to want to resuscitate very immature infants. CONCLUSION: Different treatment centers may develop their own ethos regarding resuscitation, which then shapes both the way the residents understand epidemiological data and how they make decisions.

Published 5 June 2008 in Arch Pediatr Adolesc Med, 162(6): 532-7.
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