Ethical considerations in neonatal resuscitation: clinical and research issues

The recent publication of guidelines for ethical decision making for resuscitation of infants has highlighted the problems inherent in using the currently available data to define those situations in which resuscitation should be or might be withheld or withdrawn. Prior selection criteria for resuscitation, criteria for inclusion into the study group, incomplete resuscitation, gestational age determination, intrauterine growth restriction, subjective assessment of 'poor' outcome, and other factors make setting specific parameters for acting or not acting difficult, if not dangerous, and possibly impossible. Research in neonatal resuscitation poses some potential ethical obstacles, but national and international regulations and guidelines are available to assist investigators in study design.