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Controversies in the resuscitation of infants of borderline viability

M Walden, D J Sala

    Awhonn'S Clinical Issues in Perinatal and Women'S Health Nursing
    |January 1, 1993
    PubMed

    Insights

    Resuscitating extremely preterm infants (500-750g) presents ethical challenges due to mixed outcomes. Key solutions include preventing preterm birth and establishing clear guidelines for borderline viable infant care.

    Area of Science:

    • Neonatal Medicine
    • Perinatal Technology
    • Bioethics

    Background:

    • Advances in perinatal technology create ethical dilemmas concerning the resuscitation of extremely preterm infants (500-750g).
    • Literature shows varied outcomes for these infants, with both poor and positive results documented.
    • The borderline viable infant poses significant ethical and clinical challenges.

    Purpose of the Study:

    • To discuss the ethical dilemmas surrounding the resuscitation of extremely preterm infants.
    • To explore strategies for managing borderline viable infants.
    • To formulate resolutions for ethical concerns in neonatal resuscitation.

    Main Methods:

    • A point/counterpoint format was used to examine issues related to borderline viable infants.
    • Literature review was conducted to assess outcomes and strategies.
    • Ethical considerations and clinical management options were analyzed.

    Main Results:

    • There is a lack of consensus on outcomes for infants between 500 and 750 grams.
    • Ethical challenges persist regarding the initiation and withdrawal of treatment.
    • Various strategies for managing these infants have been proposed.

    Conclusions:

    • Prevention of preterm birth is a critical first step.
    • Pre-delivery discussion of resuscitation plans and the option to withdraw treatment are essential.
    • Establishing definitive care guidelines and a standardized definition of quality of life are crucial for ethical decision-making.

    Keywords:
    Death and Euthanasia

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