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End of life care in the setting of extreme prematurity - practical challenges and ethical controversies

Dominic Jc Wilkinson1, Sophie Bertaud2

  • 1Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, UK; John Radcliffe Hospital, Oxford, UK; Murdoch Children's Research Institute, Melbourne, Australia; Centre for Biomedical Ethics, National University of Singapore Yong Loo Lin School of Medicine, Singapore.

Seminars in Fetal & Neonatal Medicine
|April 30, 2023
PubMed

Insights

End of life care for extremely preterm infants differs from other newborns due to unique challenges. This review examines end of life decisions and practices in neonatal intensive care units and delivery rooms.

Area of Science:

  • Neonatal Medicine
  • Bioethics
  • Pediatric Critical Care

Background:

  • End of life care principles are consistent across pediatric populations.
  • Practice variations exist for extremely preterm infants compared to older children and full-term newborns.
  • Neonatal intensive care units (NICUs) and delivery rooms present distinct settings for end of life care.

Purpose of the Study:

  • To review current practices in end of life care for extremely preterm infants.
  • To identify justifications for differences in end of life care for this vulnerable population.
  • To explore practical and ethical challenges associated with end of life decisions in extremely preterm infants.

Main Methods:

  • Literature review of end of life care practices.
  • Analysis of decision-making processes in neonatal settings.
  • Examination of ethical considerations in neonatal end of life care.

Main Results:

  • Significant differences in end of life care practices are observed for extremely preterm infants.
  • Specific clinical and ethical justifications underpin these care variations.
  • Practical challenges include resource allocation and communication.

Conclusions:

  • End of life care for extremely preterm infants requires tailored approaches.
  • Addressing ethical and practical challenges is crucial for optimizing care.
  • Further research is needed to refine best practices in neonatal end of life care.

Keywords:
Decision-makingEnd of lifeIntensive careNeonatalPalliative carePremature infant

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