Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Section 1 Core issues in clinical pediatric ethics
- Section 2 Ethical issues at the beginning of life: perinatology and neonatology
- 10 Maternal–fetal conflicts
- 11 Fetal intervention and fetal care centers
- 12 Ripped from the headlines: assisted reproductive technology and multiple births
- 13 Preimplantation and prenatal genetic testing for inherited diseases, dispositions, and traits
- 14 Decision-making in the delivery room
- 15 Withholding and withdrawing life-sustaining intervention from neonates
- 16 The role of quality of life assessments in neonatal care
- 17 Variations of practice in the care of extremely preterm infants
- Section 3 When a child dies: ethical issues at the end of life
- Section 4 Ethical issues posed by advances in medical technology and science
- Section 5 Children, public health, and justice
- Section 6 Special topics in pediatric ethics
- Index
- References
14 - Decision-making in the delivery room
from Section 2 - Ethical issues at the beginning of life: perinatology and neonatology
Published online by Cambridge University Press: 07 October 2011
Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- Section 1 Core issues in clinical pediatric ethics
- Section 2 Ethical issues at the beginning of life: perinatology and neonatology
- 10 Maternal–fetal conflicts
- 11 Fetal intervention and fetal care centers
- 12 Ripped from the headlines: assisted reproductive technology and multiple births
- 13 Preimplantation and prenatal genetic testing for inherited diseases, dispositions, and traits
- 14 Decision-making in the delivery room
- 15 Withholding and withdrawing life-sustaining intervention from neonates
- 16 The role of quality of life assessments in neonatal care
- 17 Variations of practice in the care of extremely preterm infants
- Section 3 When a child dies: ethical issues at the end of life
- Section 4 Ethical issues posed by advances in medical technology and science
- Section 5 Children, public health, and justice
- Section 6 Special topics in pediatric ethics
- Index
- References
Summary
Case narrative
A 26-year-old woman is admitted to the Labor and Delivery Unit in early labor. She is at 23 weeks’ gestation (based on last menstrual period and second trimester ultrasound) with a singleton female fetus, and the pregnancy has been unremarkable until today. The estimated fetal weight is 580 grams, and there are no apparent anomalies on the ultrasound done today. The perinatologist believes that the patient will deliver today, and requests that the neonatology team meet with the patient and her husband to discuss the prognosis and the management plan for the baby. Since choices surrounding care of the newborn might also influence obstetrical decisions, the meeting is requested immediately.
Summary of ethical issues
Decisions regarding newborn resuscitation are often made under great time pressure, either due to imminent delivery, thus limiting the time for discussion with the parents beforehand, or because specific actions may be required immediately after delivery if the child is to have a chance at survival. For this reason, it is essential to have considered the possible scenarios that may arise when the child is born and, as much as possible, to have worked through the ethical questions beforehand. There will be very little, if any, opportunity for ethical analysis or in-depth discussion at the time of delivery.
Information
- Type
- Chapter
- Information
- Clinical Ethics in PediatricsA Case-Based Textbook, pp. 77 - 82Publisher: Cambridge University PressPrint publication year: 2011
References
2009 Clinical report: antenatal counseling regarding resuscitation at an extremely low gestational agePediatrics 124 422Google Scholar
2001 Principles of Biomedical EthicsNew YorkOxford University Press
2008 Evidence-based ethics in the “gray zone” of neonatal viability: promises and limitationsPediatric Health 2 777Google Scholar
2005 Poor predictive validity of the Bayley scales of infant development for cognitive function of extremely low birth weight children at school agePediatrics 116 333Google Scholar
2008 The best-interest standard is not applied for neonatal resuscitation decisionsPediatrics 121 963Google Scholar
2010 Neonatal resuscitation: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular carePediatrics 126 e1400Google Scholar
2007 Babies between a rock and a hard place – neonatologists vs parents at the edge of infant viabilityActa Paediatrica 96 153Google Scholar
2005 Physicians’ refusal to resuscitate at borderline gestational ageJournal of Perinatology 25 685Google Scholar
2010 www.nichd.nih.gov/about/org/cdbpm/pp/prog_epbo/epbo_case.cfm
2010 Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research NetworkPediatrics 126 443Google Scholar
2008 Intensive care for extreme prematurity – moving beyond gestational ageNew England Journal of Medicine 358 1672Google Scholar
2008 The ethics of delivery-room resuscitationSeminars in Fetal and Neonatal Medicine 13 440Google Scholar
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