Perspectives on Resuscitation Decisions at the Margin of Viability among Specialist Newborn Care Providers in Ghana and Ethiopia: A Qualitative Analysis

BMC Pediatrics

Sara Aynalem Haimanot¹  Solomie Jebessa Deribessa¹  Sharla Rent²  Gyikua Plange-Rhule³  Cheryl A. Moyer⁴  Stephanie K. Kukora⁵  Yemah Bockarie⁶  Ashura Bakari⁷ 

[1] Department of Pediatrics and Child Health, St. Paul’s Hospital Millennium Medical College, Swaziland St, Addis Ababa, Ethiopia;Department of Pediatrics, Duke University, Durham, USA;Department of Pediatrics, Komfo Anokye Teaching Hospital Okomfo Anokye Road, Kumasi, Ghana;Departments of Learning Health Sciences and Obstetrics and Gynecology, Michigan Medicine, University of Michigan, Ann Arbor, USA;Division of Neonatal Perinatal Medicine, Department of Pediatrics, Michigan Medicine, University of Michigan, Ann Arbor, USA;Interberton Road, Cape Coast Teaching Hospital, Cape Coast, Ghana;Suntreso Government Hospital, Ghana Health Service, Kumasi, Ghana;

关键词: Neonatal Resuscitation;    Margin of Viability;    Newborn Health;    Global Health;    Ghana;    Ethiopia;    Neonatal Ethics;   

DOI  :  10.1186/s12887-022-03146-z

来源: Springer

【 摘 要 】

BackgroundIn high income countries, guidelines exist recommending gestational age thresholds for offering and obligating neonatal resuscitation for extremely preterm infants. In low- and middle- income countries, this approach may be impractical due to limited/inconsistent resource availability and challenges in gestational dating. Scant literature exists on how clinicians in these settings conceptualize viability or make resuscitation decisions for premature infants.MethodsQualitative interviews of interprofessional neonatal clinicians were conducted in Kumasi, Ghana, at Komfo Anokye Teaching Hospital and Suntreso Government Hospital, and in Addis Ababa, Ethiopia, at St. Paul’s Hospital Millennium Medical College. Transcribed interviews were coded through the constant comparative method.ResultsThree discrete major themes were identified. The principal theme was a respect for all life, regardless of the likelihood for survival. This sense of duty arose from a duty to God, a duty to the patient, and a duty intrinsic to one’s role as a medical provider. The duty to resuscitate was balanced by the second major theme, an acceptance of futility for many premature infants. Lack of resources, inappropriate staffing, and historically high local neonatal mortality rates were often described. The third theme was a desire to meet global standards of newborn care, including having resources to adopt the 22–25-week thresholds used in high income countries and being able to consistently provide life-saving measures to premature infants.ConclusionsNeonatal clinicians in Ghana and Ethiopia described respect for all life and desire to meet global standards of newborn care, balanced with an awareness of futility based on local resource limitations. In both countries, clinicians highlighted how wide variations in regional survival outcomes limited their ability to rely on structured resuscitation guidelines based on gestational age and/or birthweight.

【 授权许可】

CC BY