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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
From how small is too small to how much is too much. Ethical issues at the limits of neonatal viability
1Department of Pediatrics, University of California at Irvine, Orange, USA.
Insights
Survival rates for extremely low birthweight infants have improved, but high morbidity and extensive costs persist. Ethical considerations and decision-making strategies for neonatal care require careful examination.
Area of Science:
- Neonatal Medicine
- Medical Ethics
- Public Health Economics
Background:
- Significant advancements in neonatal intensive care have improved survival rates for extremely low birthweight (ELBW) infants.
- Despite improved survival, ELBW infants experience high rates of short- and long-term morbidity.
- The care of ELBW infants incurs substantial costs, including physical suffering for the infant, emotional and financial burdens for families, and societal economic impact.
Purpose of the Study:
- To address the complex ethical and resource allocation questions surrounding the care of extremely low birthweight infants.
- To explore the boundaries of medical intervention ('How small is too small?', 'How much is too much?').
- To examine the affordability and decision-making processes for neonatal intensive care, ensuring just strategies are employed.
Main Methods:
- Discussion of controversial questions regarding the limits of medical intervention for ELBW infants.
- Analysis of the ethical, familial, and societal implications of intensive neonatal care.
- Exploration of frameworks for just decision-making in neonatal resource allocation.
Main Results:
- Improved survival for ELBW infants is contrasted with persistently high morbidity.
- The costs associated with ELBW infant care are extensive, encompassing infant suffering, family stress, and financial burdens.
- Key ethical dilemmas include determining appropriate intervention levels, affordability, and equitable decision-making processes.
Conclusions:
- The improved survival of ELBW infants necessitates a re-evaluation of the balance between intervention, morbidity, and cost.
- Ethical frameworks are crucial for navigating difficult decisions regarding the extent and limits of neonatal care.
- Developing just strategies for decision-making is essential to manage resources and address the multifaceted burdens of ELBW infant care.
Abstract:
In recent years, survival of the extremely low birthweight infant has dramatically improved. Morbidity, both short- and long-term, however, remains very high Costs in the currency of pain and suffering for the newborn, stress and financial burdens for the family, and dollars for society are extensive. The controversial questions that are discussed include: How small is too small? How much is too much? How far should we go? How much can we afford? Who should decide? What strategies should be followed to ensure such decisions are just?
