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Defining the Threshold at which Health Care Professionals Consider Withdrawing Life Sustaining Ventilation in Neonatology

Sandesh Shivananda, Kyong-Soon Lee, Krishelle Marc-Aurele, Jonathan Hellmann, Susan Braid and Jae H Kim

Objective: To determine the variation in healthcare provider perspectives regarding Withdrawing Life Sustaining Ventilation (WLSV) in Neonatology.
Methods: We surveyed physicians, nurses, respiratory therapists, social workers, occupational and physical therapists, and neonatal pharmacists at two North American neonatal intensive care units to assess how neonatal healthcare providers use numerical risk to assist decision-making in Withdrawing Life Sustaining Ventilation. The survey presented nine scenarios depicting varying projected disabilities (single and multiple) at 3 years of age. Participants were asked to choose a predicted risk for the proposed disabilities (threshold) at which they would consider offering the WLSV option to parents. Ten additional questions regarding demographic information, attitudes, beliefs, and personal experiences were included.
Results: The response rate was 59% (332/562). Respondents were primarily female nurses. For all respondents, the choice of WLSV was offered at statistically increasing frequency for the following disabilities: deafness, blindness, cerebral palsy, and mental retardation. The risk of severe mental retardation was the strongest influencing variable. The median choice for risk of severe mental retardation alone (61-70% risk) showed no significant difference from the median choice for risk of multiple disabilities (two or more). Median responses were not significantly different with respect to age, number of children, ethnic origin, occupation, religion, strength of religious belief, or knowledge of a friend/relative with impairments.
Conclusions: Poor cognitive outcome is the principal determinant in WLSV decision-making among health care providers.