intensive care for very low birthweight infants in south africa a survey of physician attitudes parent counseling and resuscitation practices improving outcomes have promoted utilization of intensive care for premature infants in developing countries with available fiscal and technological resources physician counseling and decisionmaking have not been characterized where economic restrictions governmental guidelines and physician cultural attitudes may influence decisions about the appropriateness of neonatal intensive care a crosssectional survey of all neonatologists and pediatricians providing neonatal care in public and private hospitals in south africa n394 was carried out physicians returned 93 surveys 24 per cent response rate frequency of counseling increased with increasing gestational age ga but was not universally provided at any ga morbidity and mortality were consistently discussed and fiscal considerations frequently discussed when antenatal counseling occurred resuscitation thresholds were 2526 weeks and 665685 g and were higher in public than in private hospitals decisions to limit resuscitation were based more on expected outcome than on patients wishes or economics at 2425 weeks 91 per cent of physicians would not resuscitate despite parents wishes 93 per cent of physicians would resuscitate 2829weekold infants over parents refusal parents expecting premature infants are not invariably counseled in making lifesupport decisions physicians consider infants best interests and less frequently financial and emotional burdens thresholds for resuscitation and intensive care are higher in public hospitals and higher than in developed countries physicians relegate parents to a passive role in lifesupport decisions