Journal of perinatology : official journal of the California Perinatal Association
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Biography Historical Article
Approaches to end-of-life decision-making in the NICU: insights from Dostoevsky's The Grand Inquisitor.
For many parents stopping life-sustaining medical treatment on their dying infant is psychologically impossible. Dostoevsky's insights into human behavior, particularly the fact that individuals do not want the anxiety and guilt associated with responsibility for making difficult decisions, might change the way physicians approach parents for permission to withdraw life-prolonging medical interventions on dying infants.
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The Committee on Research in Neonatology from the Section on Perinatal Pediatrics, American Academy of Pediatrics presents an overview of the update of the Neonatal-Perinatal Training Program Survey obtained in 2002 to 2003. Our goal was to update the last survey in 1996 and to begin to assess research resources and the potential for training life-career physician scientists (basic and clinical investigators).
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To determine accuracy of the 7-8-9 Rule in a cohort of neonates. ⋯ The 7-8-9 Rule appears to be an accurate clinical method for endotracheal tube placement in neonates weighing more than 750 g. When the 7-8-9 Rule is applied to infants weighing <750 g, caution is warranted. The current rule may lead to an overestimated depth of insertion and potentially result in clinically significant consequences.
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To determine if a change in the pulse oximeter goal range and high alarm limit for oxygen saturation (SpO2) alters the distribution of SpO2 for premature infants in oxygen. ⋯ Changes in pulse oximeter policy and alarms in labile, sick premature infants need evaluation for their effects on the distribution of SpO2 values before routine use.
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The Supreme Court of Texas in the case of Miller v. HCA announced a rule in 2003 (118 s.w. 3d 758) that a physician attending the delivery of a severely premature infant may provide life-sustaining treatment for that infant under 'emergent circumstances' as a matter of law without first obtaining parental consent. This paper examines issues of law and ethics relevant to decisions about infant resuscitation at the border of viability. It is argued that there is typically no emergency when infants are delivered at 23 weeks gestation, and parents should be asked for informed consent before resuscitation in the delivery room.