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 Vol. 10 No. 6, June 2009
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NeoReviews Vol.10 No.6 2009 e270
© 2009 American Academy of Pediatrics

Decision-making in Neonatal Intensive Care

Interventions on Behalf of Preterm Infants

John Colin Partridge, MD, MPH*
Brian J. Dickey*

* Department of Pediatrics, University of California San Francisco, San Francisco, Calif

This review traces the history of judicial and legislative interventions into proxy decision-making by parents and physicians on behalf of neonates in intensive care units. The doctrine of parens patriae is traced from the first governmental intrusions into life-support decisions for newborns who had congenital anomalies during the 1980s to the 2002 federal legislation on the legal status of "born-alive" infants. Ethical problems inherent in decisions to resuscitate and provide neonatal intensive care for extremely preterm infants are discussed. A formal shared decision-making approach to care in the neonatal intensive care unit (NICU) could limit the need for legal or legislative intrusions into the complex decisions about the appropriateness of care for infants born at the margin of viability.

Abbreviations: AAP: American Academy of Pediatrics • BAIPA: Born-Alive Infants Protection Act of 2002, Public Law 107–207 • DHHS: Department of Health and Human Services • CAA: Child Abuse Amendments of 1984 • CAPTA: Child Abuse Prevention and Treatment Act • EMTALA: Emergency Medical Treatment and Labor Act • NICHD: National Institute of Child Health and Human Development • NICU: neonatal intensive care unit


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Copyright © 2009 by the American Academy of Pediatrics.