VALIDATION AND PRELIMINARY RESULTS OF A SURVEY ON DECISION OF TREATMENT IN NEONATAL CRITICAL INFANTS ADMINISTERED TO NEONATOLOGISTS IN BUENOS AIRES, ARGENTINA

Abstract

Therapeutic decision in critically ill infants with neurological damage and poor future quality of life has raised a profound ethical discussion. Validation of surveys is a useful tool to strengthen the results obtained and appears to be an optimal procedure to analyze this debate, particularly if they focus on the clinical behavior in neonatologists in undeveloped countries. The goals of this paper have been twofold. Firstly, to show the process of validation of a survey to be administered to 580 argentine neonatologists which represent one third of the total number of specialists in Argentina. Secondly, to show some preliminary results correlating euthanasia, treatment withdrawal and probable quality of life. For validation a pilot study in neonatologists was divided in two steps. Step one corresponded to evaluation of the survey by 20 pediatricians. These physicians considered if the timing to complete the survey was reasonable. Also they had to consider the clarity and self-explaining characteristics of the survey. The results of this step were positive for all these parameters. The second step of the pilot study verified whether or not the survey specifically explored the research fields previously described. That is if the survey reached significant levels of reliability by means of internal consistency. Cronbach alfa was 0.94 in all 138 surveys analyzed. Factorial analysis allowed extraction of two factors (roots) with explained variances, 48.9% and 33.4% that corresponded, respectively, to fields of euthanasia and treatment withdrawal. The non parametric test of Spearman showed significant levels of correlation for decisions referring to a: euthanasia, treatment withdrawal and quality of life. Preliminary results of the survey also showed that 98% of Neonatologists rejected euthanasia and more than 70% disagree with suspension of life support treatment both in the neonate with good neurological perspective and bad life prognosis and when there was a bad neurological perspective and a good life prognosis. Our survey is viable and has a high internal consistency established according to Cronbach alfa coefficient. Correlations showed a significant association between euthanasia and life support treatment withdrawal and between quality of life and resuscitation also with the existence of congenital malformations. Finally, our preliminary results show that argentine neonatologists reject euthanasia.