Early human development
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Early human development · Mar 2012
Risk factors for intubation-surfactant-extubation (INSURE) failure and multiple INSURE strategy in preterm infants.
The INSURE method, which consists of an intubation-surfactant-extubation sequence, is effective in reducing the need for mechanical ventilation (MV), the duration of respiratory support, and the need for surfactant replacement in preterm infants with respiratory distress syndrome. Although beneficial, the INSURE method fails to avoid MV in selected patients. We demonstrated that body weight <750 g, pO(2)/FiO(2) <218, and a/ApO(2) <0.44 at the first blood gas analysis are independent risk factors for INSURE failure in infants with gestational age <30 weeks. Moreover, we demonstrated that the INSURE treatment can be safely repeated with the aim to avoid MV, since the respiratory outcome did not differ between infants treated with single or multiple INSURE procedures.
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Early human development · Feb 2012
ReviewParents perceptions of withdrawal of life support treatment to newborn infants.
The decision to withdraw life support challenges health care professionals and parents. Parents need to fulfil their role as parents, part of which involves difficult decision making. They desire to fully understand the care of their infant in order to help in this process. ⋯ Available approaches to care need to address ethical decisions regarding treatment, pain and suffering, quality of life and decisions to move from active to palliative care. Communication requires an investment of time, repeated discussions and a compassionate approach by health care professionals to educate parents in order for them to make an informed decision. Follow-on care to help parents come to terms with the decisions they have made is a requirement of good practice.
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Palliative care for the newborn is a developing area. There are more than 2000 estimated neonatal deaths each year in the UK from causes likely to benefit from palliative care. ⋯ K. association for children's palliative care). We attempt to answer the question: 'What does the provision of good neonatal palliative care look like?' by examining the factors important in the provision of such care.
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Early human development · Feb 2012
ReviewWithholding or withdrawal of life sustaining treatment for newborn infants.
In the last two decades the survival of extreme preterm infants and sick newborn infants has improved significantly due to the advances in perinatal medicine. Despite this advance, for some babies, withholding or withdrawal of life sustaining treatment may be the best option in the interest of the baby. ⋯ The decision making process and factors influencing parents decision, how to resolve disagreement, what treatment can be withheld or withdrawn are explained. High quality palliative care must be provided after withholding or withdrawal of life sustaining treatment.
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Early human development · Feb 2012
Withdrawal of life-sustaining treatment for newborn infants from a Christian perspective.
The more vulnerable a person, of whatever age, therefore, the more there must be a presumption in favour of life; and care must be offered with particular respect and dignity, and in the best interests of the infant her/himself, not in those of others. The principles, that guide Christians in making ethical healthcare decisions, were derived from two core Christian beliefs: that all human beings, of whatever age, are "made in the image of God"--so human beings have a distinctive dignity and value, and may not be treated as possessions or commodities; and that we are therefore made to live relationally--so communal, as well as individual, perspectives ought to be considered in ethical decision-making. The article then notes and explores three areas in which it may not be in the infant's best interests for life-sustaining treatment to continue or to be initiated, noting the complexity of "quality of life" questions, and the danger of considering others' quality of life over that of the infant. So, to safeguard the vulnerable, the threshold for acceptable "quality of life" needs to be set at a "low" level; and a distinction should be drawn, in considering withdrawing life-sustaining treatment, between medical intervention and "assisted-care" - so that there are very limited circumstances in which life-sustaining treatments ought to be withheld or withdrawn from newborn infants.