Ethical decision making for critically ill infants in eight Asian countries: an international survey

BACKGROUND: Families and healthcare providers of sick newborns or periviable extremely preterm infants in NICUs sometimes need to make ethical decisions regarding the withdrawal or withholding of life-sustaining treatments. Although international variations have been reported, data from other Asian countries are limited. This study assesses this topic in Asia. METHODS: A web-based questionnaire survey was sent to the representatives of 408 NICUs in neonatal networks across eight Asian countries (Indonesia, Japan, Malaysia, the Philippines, Singapore, South Korea, Taiwan, and Thailand). The five questions asked how often the facility provided life-sustaining treatment for certain newborn scenarios with potentially poor prognosis. The answer options were "routinely" (90-100% of cases), "often" (50-89%), "sometimes" (10-49%), "rarely" (1-9%), and "never" (0-1%). The results were summarized as percentages of answers given. RESULTS: A total of 310/408 NICUs (76%) across Asian countries responded to the survey. The proportion of facilities that "routinely" or "often" provided withdrawal of life-sustaining treatment for bilateral intraventricular hemorrhage varied widely among the networks (0%-100%). Higher proportions of facilities from Japan (44%) and South Korea (33%) "routinely" provided active resuscitation to infants born at 22 weeks gestation compared with those from other countries (0-20%). The proportion of facilities that actively resuscitated infants born at 23, 24, and 25 weeks gestation in each network ranged from 0 to 85%, 9-100%, and 28-100%, respectively. For infants born at 26 weeks gestation or more and those with a birth weight of 600 g or more, the majority of facilities (≥60%) "routinely" provided active resuscitation in all countries. CONCLUSIONS: Ethical decisions varied widely among Asian countries, especially for infants born at 22-25 weeks gestation.