BackgroundDeciding whether to resuscitate extremely preterm infants (EPIs) is clinically and ethically problematic. The aim of the study was to understand neonatologists’ clinical–ethical decision-making for resuscitation of EPIs.MethodsWe conducted a qualitative study in Belgium, following a constructivist account of the Grounded Theory. We conducted 20 in-depth, face-to-face, semi-structured interviews with neonatologists. Data analysis followed the qualitative analysis guide of Leuven.ResultsThe main principles guiding participants’ decision-making were EPIs’ best interest and respect for parents’ autonomy. Participants agreed that justice as resource allocation (...) should not be considered in resuscitation decision-making. The main ethical challenge for participants was dealing with the conflict between EPIs’ best interest and respect for parents’ autonomy. This conflict was most prominent when parents and clinicians disagreed about births within the gray zone (24–25 weeks). Participants’ coping strategies included setting limits on extent of EPI care provided and rigidly following established guidelines. However, these strategies were not always feasible or successful. Although rare, these situations often led to long-lasting moral distress.ConclusionsParticipants’ clinical–ethical reasoning for resuscitation of EPIs can be mainly characterized as an attempt to balance EPIs’ best interest and respect for parents’ autonomy. This approach could explain why neonatologists considered conflicts between these principles as their main ethical challenge and why lack of resolution increases the risk of moral distress. Therefore, more research is needed to better understand moral distress in EPI resuscitation decisions.Clinical Trial Registration: The study received ethical approval from the ethics committee of UZ/ku Leuven (S62867). Confidentiality of personal information and anonymity was guaranteed in accordance with the General Data Protection Regulation of 25 May 2018. (shrink)

Multidimensional property supplementation is a grounded theory method for analysis that conceives of concepts as multidimensional spaces of possibilities. It is applied in an iterative process comprising four steps: expansion, whereby vague codes are split and contraries postulated; abstraction of practically significant differences in terms of properties and dimensions; geometrization of properties to create conceptual subspaces that supplant subcategories and have additional, emergent qualities; and unification of the concept by validating it against data and relieving it of properties that do (...) not tie in sufficiently with other concepts. Multidimensional conceptual models encourage the researcher to elaborate properties that explain, predict, or guide action. Fully developed, they can be easily connected to others in a process and function, by virtue of their emergent qualities, as falsifiable hypotheses in their own right. For these reasons, multidimensional property supplementation is open to epistemological justification without presuming acceptance of techniques specific to grounded theory. (shrink)