Use of animal surfactant: should we seek consent?
R Adappa1,
R Benson1,
S Oddie2,
J Wyllie2
1Department of Paediatrics, Ysbyty Gwynedd, Bangor, N Wales, UK
2Neonatal Intensive Care Unit, James Cook University Hospital, Middlesbrough, UK
Dr Adappa;
Roshanadappa{at}aol.com
http://dx.doi.org/10.1136/fn.88.4.F351-a
parents' views
Animal derived surfactants such as Curosurf (porcine) and Survanta (bovine) are the commonly used surfactants in the United Kingdom. Involvement in a trial of a new artificial surfactant, and the specific information on the origins of the surfactant in the patient information leaflet led us to review our practice. Two families declined to participate in the trial. A Hindu family wished to avoid use of Survanta, as cows are considered sacred in Hindu religion. A Moslem family preferred to avoid porcine products. Having reviewed our own practice, we were unsure as to the practice of other units.
We telephoned the second on call doctors in 42 teams providing newborn resuscitation and initial surfactant therapy to preterm infants in England and Wales. Respondents were asked about which surfactant was available and whether the constituents were usually discussed with parents.
Only nine of 42 respondents said that they would routinely discuss the constituents of the surfactant with the families and could remember having done so in the recent past.
Twenty two respondents in England said that their units only stocked Curosurf, two units stocked Survanta, and three units stocked Curosurf and Survanta. One did not know which surfactant was available. In Wales, 13 units had only Curosurf and one unit stocked both Curosurf and Survanta.
We were surprised by the number of people who had thought about this being a possible problem. With many units choosing to stock only one surfactant, we think that it is important to keep all parents fully informed both of the importance of early administration and the nature of the available surfactants.
We suspect that, when fully informed, most parents would agree to a life saving medicine. However, we are not sure if this consent should be presumed where there are grounds to wonder if this may be a problem. Individual families still need to make their own decisions to avoid the perception that the medical profession has a patronising attitude.
We hope to generate a discussion to see if a consensus can be evolved.