Related Experiment Video
Updated: Sep 26, 2025
Modeling Neonatal Intraventricular Hemorrhage Through Intraventricular Injection of Hemoglobin
Published on: August 25, 2022
Ethical considerations in the management of infants with severe intraventricular hemorrhage
Marlyse F Haward1, Deborah E Campbell1
1Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, United States.
Insights
Predicting neurological outcomes for infants with severe intraventricular hemorrhage (IVH) is complex. Neurological findings alone rarely justify care changes; the infant's overall condition must be considered.
Area of Science:
- Neonatal Neurology
- Bioethics
- Pediatric Neurodevelopmental Outcomes
Background:
- Neonatal care presents unique challenges for predicting neurological outcomes in infants with severe intraventricular hemorrhage (IVH).
- Prognostication in severe IVH complicates bioethical principles, including futility, parental values, and the child's best interests.
- Decision-making is influenced by prognostic uncertainty and assumptions about quality of life.
Purpose of the Study:
- To review bioethical principles and concepts relevant to neonatal care and severe IVH.
- To explore challenges in decision-making for infants with severe IVH.
- To provide practical approaches for counseling parents on neurodevelopmental impairment.
Main Methods:
- Review of bioethical principles and relevant literature.
- Exploration of decision-making challenges in severe IVH.
- Discussion of counseling strategies for parents.
Main Results:
- Neurological findings in severe IVH often do not solely warrant redirection of care.
- Consideration of the entire neonatal condition is crucial for care decisions.
- Prognostic uncertainty and quality-of-life assumptions impact counseling.
Conclusions:
- Bioethical decision-making in neonatal neurology requires a holistic approach.
- Care redirection for severe IVH should integrate neurological status with overall neonatal condition.
- Effective parental counseling necessitates addressing prognostic uncertainty and quality of life.
Abstract:
Intrinsic and extrinsic factors unique to neonatal care can complicate predictions of neurological outcomes for infants who suffer from severe intraventricular hemorrhage. While care decisions are driven by the same bioethical principles used in other domains, neurological prognostication can challenge concepts of futility, require careful examination of parental values, uncover biases and/or potentially compromise the best interests of the future child. In the following chapter we will review bioethical principles and relevant concepts, explore challenges to decision-making surrounding diagnoses of severe intraventricular hemorrhage and conclude with a brief review of practical approaches for counseling parents about neurodevelopmental impairment given the constraints of prognostic uncertainty and assumptions related to quality of life. We will argue that neurological findings alone, even in the setting of severe intraventricular hemorrhage, often do not constitute enough evidence for redirection of care but can be permissible when the entire neonatal condition is considered.
