Seminars in perinatology
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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.
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Cirrhosis and portal hypertension infrequently coincide with pregnancy but increase maternal and fetal morbidity and mortality when present. Chronic liver disease and portal hypertension are not contraindications to pregnancy but necessitate intensive monitoring throughout pregnancy. ⋯ Provision of optimal care for mother and fetus can require the skills of multiple specialties such as maternal fetal medicine, gastroenterology, nutrition, and surgery. This report provides guidelines for the management of cirrhosis and portal hypertension in pregnancy.
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Acute fatty liver of pregnancy is a rare clinical entity unique to pregnancy that occurs during the third trimester. The obstetric team must be familiar with this disease because early diagnosis and prompt delivery have dramatically improved prognosis, which was often fatal for both mother and child. ⋯ The cause is unknown, but some cases of acute fatty liver of pregnancy have been associated with a genetic deficiency of fatty acid beta-oxidation. Because of the possibility of this congenital deficiency, infants of affected mothers should undergo close follow-up from birth.
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Seminars in perinatology · Feb 1998
ReviewThe role of intravenous immunoglobulin for the prevention and treatment of neonatal sepsis.
The use of intravenous immunoglobulin (IVIG) for the prevention and treatment of sepsis in neonates is appealing because of the relative immunodeficiency of the neonate and the desire to improve the relatively poor outcome even with optimal antimicrobial treatment. The effectiveness of IVIG for these uses has been studied in numerous prospective as well as retrospective small and large trials that have had discordant conclusions. ⋯ In contrast, meta-analysis of studies of IVIG for the treatment of neonates with sepsis shows a significant and unequivocal sixfold decrease in the mortality rate (P = .007, two-sided) when IVIG is administered in addition to standard therapies. The additional benefit of decreasing the risk for acute mortality indicates that the inclusion of IVIG should be considered a part of the routine therapy of neonatal sepsis.