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Trisomy 18 and complex congenital heart disease: seeking the threshold benefit

Renee D Boss1, Kathryn W Holmes, Janyne Althaus

  • 1Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins University School of Nursing, Baltimore, MD, USA. rboss1@jhmi.edu

Pediatrics
|June 5, 2013
PubMed

Insights

Prenatal diagnosis of complex congenital heart disease in trisomy 18 presented ethical challenges. Medical teams debated treatment burdens versus neonatal benefits, prompting an ethics consultation.

Area of Science:

  • Medical Ethics
  • Neonatal Cardiology
  • Prenatal Diagnosis

Background:

  • A fetus with trisomy 18 was diagnosed prenatally with ductal-dependent, complex congenital heart disease.
  • Parents requested exclusion of genetic diagnosis from medical decisions and full life-prolonging therapies for their infant.

Observation:

  • Conflict arose within the medical team regarding the threshold of neonatal benefit to justify maternal and neonatal treatment burdens.
  • A prenatal ethics consultation was requested to address the complex ethical dilemma.

Findings:

  • The case highlights the intricate ethical considerations in managing complex congenital heart disease in fetuses with chromosomal abnormalities.
  • Disagreements centered on balancing potential neonatal outcomes against the burdens of intensive medical interventions.

Implications:

  • Prenatal ethics consultations are crucial for navigating complex decisions in fetal medicine and congenital heart disease.
  • This case underscores the need for clear guidelines and communication protocols when parental wishes conflict with medical team recommendations.
  • It emphasizes the importance of considering quality of life and treatment burdens in neonatal care decisions.

Keywords:
cardiac surgerydecision-makingethicstrisomy 18

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