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Published on: April 7, 2023
Decision-making for extremely preterm infants with severe hemorrhages on head ultrasound: Science, values, and
M Chevallier1, K J Barrington2, P Terrien Church3
1Department of Neonatal Intensive Care Unit, CHU Grenoble, Grenoble, France; TIMC-IMAG Research Department; Grenoble Alps University; Grenoble, France.
Insights
Severe intracranial hemorrhages in extremely preterm infants often necessitate difficult ethical decisions regarding life-sustaining interventions. Prognosis varies based on lesion characteristics and complications, guiding personalized care discussions with parents.
Area of Science:
- Neonatal Medicine
- Medical Ethics
- Pediatric Neurology
Background:
- Severe intracranial hemorrhages (ICH) are common in extremely preterm infants, often coinciding with critical interventions.
- These hemorrhages raise significant ethical considerations regarding the level of care and treatment decisions.
Purpose of the Study:
- To review the variable prognosis of ICH in extremely preterm infants.
- To outline ethically appropriate discussions with parents regarding life-sustaining therapy decisions.
- To emphasize personalized decision-making based on prognosis and parental values.
Main Methods:
- Review of existing literature on ICH prognosis in extremely preterm infants.
- Analysis of factors influencing outcomes, including lesion characteristics and complications.
- Framework development for ethical discussions on continuing life-sustaining therapy.
Main Results:
- Prognosis for ICH in extremely preterm infants is highly variable.
- Outcomes depend on hemorrhage extent, location, laterality, and subsequent clinical events.
- Effective communication strategies can facilitate compassionate and honest parental engagement.
Conclusions:
- Prognosis assessment and parental values are crucial for making informed decisions about life-sustaining therapy.
- Discussions should focus on personalized information, function, and individual patient needs.
- Ethical decision-making requires a compassionate approach, balancing medical information with family values.
Abstract:
Severe intracranial hemorrhages are not rare in extremely preterm infants. They occur early, generally when babies require life-sustaining interventions. This may lead to ethical discussions and decision-making about levels of care. Prognosis is variable and depends on the extent, location, and laterality of the lesions, and, importantly also on the subsequent occurrence of other clinical complications or progressive ventricular dilatation. Decision-making should depend on prognosis and parental values. This article will review prognosis and the uncertainty of outcomes for different lesions and provide an outline of ways to conduct an ethically appropriate discussion on the decision of whether to continue life sustaining therapy. It is possible to communicate in a compassionate and honest way with parents and engage in decision-making, focussing on personalized information and decisions, and on function, as opposed to diagnosis.
