Background The Born-Alive Infant Protection Act of 2002 (BAIPA) defined the legal status of infants showing any sign of life; it did not mandate resuscitation. In April 2005, the federal government issued guidelines on enforcement of BAIPA, obligating treatment of all live-born infants without regard to gestational age (GA) or birth weight (BW).
Methods We surveyed all neonatologists in California (n = 360). The mailed questionnaire asked physicians how their current resuscitation and neonatal intensive care practices for likely nonviable infants (20-24 wks GA) would change in response to enforcement of BAIPA.
Results We received 87 completed questionnaires (response rate = 20%, to date); 8 physicians refused participation. Most respondents had not heard of BAIPA (64%) or enforcement guidelines (81%). Only 7% believed these guidelines should be enforced. Most respondents agreed that BAIPA clarified the definition of born-alive infants (68%) but criticized the guidelines as inappropriate governmental regulation of medical care (93%), not standard of care (93%), and not evidence based (95%). Respondents felt that enforcement of BAIPA would increase number of 20 to 23 6/7wk GA infants being resuscitated (89%), prompt overly aggressive treatment of nonsurvivors (89%), and restrict options to withhold or withdraw life support (79%). Regarding personal practices, respondents would not lower their current minimum GA or BW thresholds for routine resuscitation if BAIPA were enforced, but they would lower the maximum GA and BW at which they would allow only palliative care (Table).
Conclusions Although most California neonatologists regard BAIPA as inappropriate governmental intervention in perinatal care, their practices may change if this legislation is enforced. Since most 20-24 wk GA infants do not survive, government enforcement of BAIPA may motivate physicians to resuscitate nonviable infants. Government intervention in resuscitation decisions for likely nonviable extremely premature infants could increase health care costs, prolong suffering in children who die, or augment survival of children with major disabilities.
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