Seminars in perinatology
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Seminars in perinatology · Jun 1998
ReviewFutility considerations in the neonatal intensive care unit.
The purpose of this article is to summarize and comment on the history of medical decision making in the neonatal intensive care nursery, emphasizing considerations of futility. Several epochs will be described, with shifting roles of health care providers, the infant's family, and proxies for society at large. Futility has been an issue in the intensive care of newborn infants throughout the last 35 years. ⋯ In the 1990s, third party payors became increasingly assertive in limiting resource expenditure. These legal and societal mandates are frequently at variance with one another. Thus the issue of medical futility, as it applies to neonates in the United States, must be considered unresolved.
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The decision to withhold or withdraw life support in the neonatal intensive care unit (NICU) is common but is never routine. Often, moral demands make such decisions difficult and emotionally exhausting. ⋯ Although these topics are relevant in any discussion of the moral justification of the omission, withdrawal, or use of treatment for patients, they are especially telling when entertained in the context of the transition of the fetus to a newborn. This article uses these four topics as a moral compass for certain decisions made in the delivery room.
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Seminars in perinatology · Jun 1998
ReviewEthical issues in the care of extremely low birth weight infants.
This article examines the difficulties in making decisions about the medical treatment of infants who have uncertain viability because of extremely low birth weight. The advantages and disadvantages of three systematic approaches are reviewed. An approach called "provisional intensive care for all" may offer the most benefit and cause the least harm. ⋯ After further assessment of the infant, the parents would be informed as fully as possible about the possible outcome of continuing intensive care. The treating physicians would offer the parents the options of continuing intensive care or withdrawing it and providing basic care. Although the physicians would provide recommendations based on their best medical judgment, they would be prepared to support and carry out the parents' decision.