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 Vol. 5 No. 11, November 2004
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NeoReviews Vol.5 No.11 2004 e471
© 2004 American Academy of Pediatrics

Ethical Issues in the Care of the Neonate

Overview

Robert J. Boyle, MD*

* Professor of Pediatrics, Department of Pediatrics, University of Virginia Health System, Charlottesville, Va

The first 300 words of the full text of this article appear below.


   Objectives
 
After completing this article, readers should be able to:

  1. Describe the points of outcome studies that require careful review.
  2. Compare the outlook of parents and clinicians in anticipating outcome.
  3. Delineate the philosophical, emotional, and psychological costs of withdrawing life-sustaining therapy.
  4. Describe the factors that can affect the prediction of outcome based on an infant’s birthweight.


   Introduction
 
Since the early days of neonatal intensive care, clinicians have reflected on the ethics of caring for critically ill neonates for whom there is significant morbidity and mortality. Sound ethical reasoning requires accurate assessment of the individual infant and accurate prognostic data on which to base discussions and decisions. Literally hundreds of studies have been published over the years regarding these outcomes. The interesting phenomenon is that the same basic questions continue to be asked about populations of infants who have lower birthweights and younger gestational ages as the specialty has progressed. Commentary from earlier periods questioned aggressive care for infants weighing less than 1,500 g, as did later commentaries about infants who weighed less than 1,000 g, and now we are discussing the same questions for those weighing less than 500 to 600 g. There always has been question and commentary from neonatologists, obstetricians, parents of "preemies," the media, and the courts about the wisdom of treating these extremely preterm infants.

More recently, partly in response to requests from clinicians, national and regional bodies have developed guidelines for decision making in the delivery room for extremely preterm infants (Table ). Some of these have been strictly consensus-based and others were consensus-based after detailed review of the published evidence. Whether attempting to make clinical decisions for a specific infant, developing guidelines for care, or questioning the moral underpinnings of care for this population, the published outcome studies form the framework. Several recent reviews have addressed . . . [Full Text of this Article]


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