Nederlands tijdschrift voor geneeskunde
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The increase in incidence of Caesarean sections in the Netherlands has resulted in improved infant outcomes in breech infants. About two hundred extra caesarean sections are needed to 'save' one baby. ⋯ These factors have to be taken into account when counselling women. Future reproductive considerations and the motivation of the woman and the gynaecologist for a vaginal breech delivery should be discussed during counselling.
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Ned Tijdschr Geneeskd · Sep 2005
Comment Case Reports[Decision-making regarding life-sustaining medical treatment in a pediatric intensive-care unit].
The complexity of the decision-making process regarding life-sustaining medical treatment was illustrated by the single case of a 12-year-old boy with severe meningococcal septicaemia. When his clinical condition deteriorated, necessitating haemodialysis and multiple amputations of the extremities, questions about the futility of treatment and the future quality of life puzzled the attending physician. ⋯ Half-a-year later he was following an intensive rehabilitation programme and the possibility of renal transplantation was contemplated. Because of the consequences for the child and his family, a decision to continue life-sustaining medical treatment should be justified as thoroughly as one to withdraw or withhold treatment.
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Ned Tijdschr Geneeskd · Sep 2005
[No conspicuous changes in the practice of medical end-of-life decision-making for neonates and infants in the Netherlands in 2001 as compared to 1995].
To establish whether the practice of end-of-life decision-making for neonates and infants under the age of 1 in the Netherlands in 2000 was different from that in 1995. ⋯ The findings suggest that the practice of end-of-life decision-making in neonatology was rather stable between 1995 and 2001. The frequency of the active termination of life had not increased, despite the new euthanasia regulation in the Netherlands.
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Ned Tijdschr Geneeskd · Sep 2005
[End-of-life decisions and reluctant treatment of newborns on the borderline of viability in the Netherlands].
End-of-life decisions are taken in the majority of deaths below one year of age, especially in neonatal intensive-care units. In the Netherlands, the frequency of such decisions has not increased in recent years. Intentional termination of life occurred in 1% of the deaths, which would be about 10 cases each year. ⋯ Dutch neonatologists are reluctant to administer full neonatal intensive care to extremely preterm infants. Currently, the policy regarding antenatal referral and treatment of extremely preterm infants is being re-evaluated by obstetricians and neonatologists. Behind the stable frequency of end-of-life decisions, difficult ethical issues remain to be solved.