Journal of perinatology : official journal of the California Perinatal Association
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Since the enactment of the Texas Advance Directives Act of 1999, the Memorial Hermann Hospital Medical Appropriateness Review Committee (MARC) MARC reviewed six cases of children in the first year of life, three from the Neonatal ICU and three from the Pediatric ICU. We aimed to describe the characteristics of these patients and the role of the MARC in this process. ⋯ These cases document the application of the TADA/MARC process in infants, even in circumstances where care was withdrawn without concurrence of the family. We found the MARC process to demand a very high degree of certainty of diagnosis and prognosis to determine continuation of care to be inappropriate. We conclude that the MARC promoted communication and provided additional protections to patients, families, physicians and staff.