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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Should Long-Term Consequences of NICU Care Be Discussed in Terms of Prognostic Uncertainty or Possible Harm?
Genevieve Allen, Naomi Laventhal1
1Assistant professor in the Department of Pediatrics and Communicable Diseases in the Division of Neonatal-Perinatal Medicine at the University of Michigan Medical School in Ann Arbor, Michigan, and a clinical ethics faculty member in the Program in Clinical Ethics within the Center for Bioethics and Social Sciences and provides clinical ethics consultation throughout the University of Michigan hospital system.
Insights
This study explores ethical decisions for extremely premature infants at the threshold of viability. It examines physician duties in predicting outcomes and framing complications, aiding parental and clinical decision-making regarding care.
Area of Science:
- Neonatal Medicine
- Medical Ethics
Background:
- Infants born at the margin of gestational viability present complex ethical challenges.
- Accurate prognostication of mortality and long-term morbidity is crucial for these infants.
Purpose of the Study:
- To analyze ethical considerations in the resuscitation of periviable infants.
- To clarify physician obligations in outcome characterization and complication framing.
- To explore the utility of a "trial of therapy" in decision-making.
Main Methods:
- Case analysis of preterm labor at the threshold of viability.
- Discussion of ethical frameworks for neonatal care decisions.
- Exploration of shared decision-making models.
Main Results:
- Physician obligations include transparently communicating potential outcomes.
- Distinguishing between prematurity complications and iatrogenic complications is ethically significant.
- A "trial of therapy" can facilitate informed parental and clinical choices.
Conclusions:
- Ethical resuscitation requires careful consideration of prognostication and complication attribution.
- Shared decision-making models, including "trial of therapy," support ethical care for periviable infants.
- Clear communication and ethical frameworks are vital for navigating end-of-life care decisions in neonatology.
Abstract:
We will examine several ethical considerations in the resuscitation of infants born at the margin of gestational viability in analyzing a case of preterm labor. More specifically, we will discuss the obligations of physicians in characterizing expected outcomes, both mortality and long-term morbidity, for extremely premature infants and how potential adverse outcomes should be framed-as complications of prematurity itself or as iatrogenic complications of care. We will also explore how the concept of a "trial of therapy" can support parents and neonatologists in decision making concerning withholding or withdrawing care for periviable infants.
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