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Clinical Practice Protocol of Creative Music Therapy for Preterm Infants and Their Parents in the Neonatal Intensive Care Unit
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When Is Intensive Care Warranted for the Most Immature Infants?
Joseph W Kaempf1, Luca Brunelli2, Alex Vidaeff3,4
1Department of Value, Research, Innovation, Women & Children's Institute, Providence St. Vincent Medical Center, Providence St. Joseph Health System Oregon, Portland, Oregon.
American Journal of Perinatology
|June 3, 2025
Summary
Decisions about high-technology interventions for extremely premature newborns involve uncertainty and risk. Shared decision-making, respecting parental values and informed consent, is crucial for navigating these complex ethical challenges in neonatology.
Area of Science:
- Neonatology
- Perinatology
- Bioethics
Background:
- High-technology interventions for extremely premature infants (22-24 weeks gestation) present significant ethical and clinical challenges.
- While survival rates are increasing, substantial morbidity and neurodevelopmental impairments persist, with outcomes varying among families.
- Maternal risks associated with delivery and the high costs of intensive care are significant considerations.
Purpose of the Study:
- To explore the complexities surrounding decisions about initiating, withdrawing, or continuing intensive care for extremely premature infants.
- To emphasize the importance of shared decision-making, informed consent, and respecting parental autonomy in neonatology.
- To address the ethical tensions between physician and parental perspectives in end-of-life care for neonates.
Main Methods:
- The study reviews current practices and ethical considerations in managing extremely premature infants.
- It analyzes the conflict between physician-driven technological imperatives and parental values and preferences.
- The paper advocates for a framework of shared decision-making endorsed by major pediatric and obstetrical organizations.
Main Results:
- Survival rates for 22-24-week infants are improving with active care, but long-term neurodevelopmental outcomes remain a concern.
- Significant disparities exist in care approaches between and within institutions and countries.
- Parental discretion in decision-making may increase due to the inherent uncertainties of extreme prematurity.
Conclusions:
- Shared decision-making, grounded in informed consent and respect for parental values, is essential for navigating care decisions for extremely premature infants.
- Physicians must provide objective outcomes, listen compassionately, and avoid presenting care as a rigid protocol or an unrestricted menu.
- Acknowledging the inherent contingencies and potential biases (nihilism or therapeutic fury) is vital for ethical practice.
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