OBSTETRICS Attitudes of Canadian Neonatologists in Delivery Room Resuscitation of Newborns at Threshold of Viability
Bibliographic record
Abstract
Objective: There is great debate regarding the extent of intensive care interventions for extremely premature newborns. In this report, we describe Canadian neonatologists ’ attitudes towards delivery room resuscitation decisions in neonates at the threshold of viability. Methods: We interviewed neonatologists (N = 121) practising in Canadian tertiary care neonatal units between June 2004 and April 2005, and asked whether they would support a parental request not to initiate resuscitation for newborns of 23 to 26 weeks ’ gestation. Bivariate analyses were performed to identify sociodemographic or cultural factors that might affect resuscitation decisions. Results: Most Canadian neonatologists would support a parental request not to initiate resuscitation of an infant at 23 and 24 weeks ’ gestation (98 % and 80%, respectively). However, we observed heterogeneity across the country in attitudes primarily at 25 weeks, but also at 24 weeks ’ gestation. At 24 weeks ’ gestation, decisions also appear to be significantly related to personal experience with a disabled close friend or relative. For newborns of 25 weeks ’ gestation, neonatologists are divided: a majority (76%) would strongly advocate resuscitation and/or resuscitate a “viable ” fetus against parental wishes, and a minority (24%) would agree not to initiate treatment. At 26 weeks ’ gestation, more than 97 % would not support a request not to initiate resuscitation. Conclusion: Attitudes of Canadian neonatologists towards resuscitation of newborns at the threshold of viability primarily differ at 25 weeks and to a lesser extent at 24 weeks of gestation. Our findings highlight important nuances in relation to existing national guidelines. Résumé Objectif: La portée des interventions de soins intensifs offertes aux nouveau-nés extrêmement prématurés suscite de grands débats. Dans le cadre de ce rapport, nous décrivons les attitudes des néonatologistes canadiens envers les décisions liées à la réanimation des nouveau-nés au seuil de la viabilité en salle d’accouchement.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.015 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.002 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".