Attitudes of healthcare providers towards non-initiation and withdrawal of neonatal resuscitation for preterm infants in Mongolia

Antenatal parental counselling by healthcare providers is recommended to inform parents and assist with decision-making before the birth of a child with anticipated poor prognosis. in the setting of a low-income country,like mongolia,attitudes of healthcare providers towards resuscitation of high-risk newborns are unknown. the purpose of this study was to examine the attitudes of healthcare providers regarding ethical decisions pertaining to non-initiation and withdrawal of neonatal resuscitation in mongolia. a questionnaire on attitudes towards decision-making for non-initiation and withdrawal of neonatal resuscitation was administered to 113 healthcare providers attending neonatal resuscitation training courses in 2009 in ulaanbaatar,the capital and the largest city of mongolia where -40% of deliveries in the country occur. the questionnaire was developed in english and translated into mongolian and included multiple choices and free-text responses. participation was voluntary,and anonymity of the participants was strictly maintained. in total,113 sets of questionnaire were completed by mongolian healthcare providers,including neonatologists,paediatricians,neonatal and obstetrical nurses,and midwives,with 100% response rate. ninety-six percent of respondents were women,with 73% of participants from ulaanbaatar and 27% (all midwives) from the countryside. the majority (96%) of healthcare providers stated they attempt pre-delivery counselling to discuss potential poor outcomes when mothers present with preterm labour. however,most (90%) healthcare providers stated they feel uncomfortable discussing not initiating or withdrawing neonatal resuscitation for a baby born alive with little chance of survival. religious beliefs and concerns about long-term pain for the baby were the most common reasons for not initiating neonatal resuscitation or withdrawing care for a baby born too premature or with congenital birth-defects. most mongolian healthcare providers provide antenatal counselling to parents regarding neonatal resuscitation. additional research is needed to determine if the above-said difficulty with counselling stems from deficiencies in communication training and whether these same counselling-related issues exist in other countries. future educational efforts in teaching neonatal resuscitation in mongolia should incorporate culturally-sensitive training on antenatal counselling. ©international centre for diarrhoeal disease research,bangladesh.