The Pediatrician at a Crossroads. The Care of Extremely Small Newborn Babies: Ethical Problems in the Delivery Room
DOI:
https://doi.org/10.14422/rib.i09.y2019.002Keywords:
infant care, extremely premature, ethics, extremely low birth weight, compassionAbstract
Ethical dilemmas are not new in perinatology. Even with the new advances in the care of pregnant women, pediatricians find themselves facing extremely small babies at the limit of survival. With parents informed of the risks of sequelae in these babies and with their decision to assist them or not, ethical decisions are transferred to the delivery room. There, the pediatrician, along with the parents, must make decisions according to the best evidence available, and the ethical approach that is established regarding those relations, rather than stressing autonomy, to a large extent favors compassion with regard to the human beings in the center of the action.Downloads
References
American Academy of Pediatrics. (1983). Comments of the on proposed rule regarding nondiscrimination on the basis of handicap relating to health care for handicapped infants. Fed Regist., 48(129), 30846-52.
Chervenak, L. B., & McCullough, A. B. (2005). Why the Groningen protocol should be rejected. NEJM (352), 23-54.
Cecchetto S. (1999). Dilemas bioéticos en medicina perinatal. Buenos Aires: Corregidor.
Cecchetto, S. (2001). Teoría y práctica del consentimiento informado en el área neonatal. 2ª. Ed. Buenos Aires: Ediciones Suárez.
Gargus, R. A., Vohr, B., Tyson, J. E., High, P., et al. (2009). Unimpaired Outcomes for Extremely Low Birth Weight Infants at 18 to 22 Months. Pediatrics, 124(1), 112-121. DOI: https://doi.org/10.1542/peds.2008-2742
Gracia, D. (1989). Fundamentos de bioética. Madrid: Eudema/Universidad de Madrid.
Grupo Colaborativo Neocosur. (2002). Very-low-birth-weight infant outcomes in 11 South American NICUs. J Perinatol, 22(1), 2-7. DOI: https://doi.org/10.1542/peds.2008-2742
Grzona, M. E. (2006). Prematuros extremos: ¿es posible establecer un límite de viabilidad? Acta bioeth, 12(1), 101-111. DOI: https://doi.org/10.4067/S1726-569X2006000100014
Hack, M., & Fanaroff, A. A. (2000). Outcomes of children of extremely low birthweight and gestational age in the 1990s. Semin Neonatol, 5(2), 89-106. DOI: https://doi.org/10.1053/siny.1999.0001
Kaempf, J. W., Tomlinson, M. W., Campbell, B., Ferguson, L., & Stewart, V. T. (2009). Counseling Pregnant Women Who May Deliver Extremely Premature Infants: Medical Care Guidelines, Family Choices, and Neonatal Outcomes. Pediatrics, 123, 1509-1515. DOI: https://doi.org/10.1542/peds.2008-2215
Kodish, E. (2008). Paediatrics ethics: a repudiation of the Groningen protocol. Lancet, 371(9616), 892-3. DOI: https://doi.org/10.1016/S0140-6736(08)60402-X
Mendoza, Y., Santander, G., Páez, V., & Barría, R. (2009). Sobrevida de neonatos de extremo bajo peso al nacer en una región del sur de Chile. Rev Chil Obstet Ginecol, (74), 225-23. DOI: https://doi.org/10.4067/S0717-75262009000400004
Niño, R. (2016). Cuidados al paciente neonatal. Cuestiones de ética. En A. Montero, R. Niño (eds.), Bioética en Salud Sexual y Reproductiva (pp. 99-108). Santiago de Chile: Editorial Mediterráneo.
Peerzada, J. M., Schollin, J., & Hakansson, S. (2006). Delivery room decision-making for extremely preterm infants in Sweden. Pediatrics, 117, 1988-1995. DOI: https://doi.org/10.1542/peds.2005-1885
Pignotti, M. S., & Donzelli, G. (2008). Perinatal care at the threshold of viability: an international comparison of practical guidelines for the treatment of extremely preterm births. Pediatrics, 121, e193. DOI: https://doi.org/10.1542/peds.2007-0513
Pless, E. (1983). The story of Baby Doe. New Engl J Med, 309(11), 663.
Robertson, J. A. (2017). Is there a right to gestate? Journal of Law and the Biosciences, 4(3), 630-636. DOI: http://doi.org/10.1093/jlb/lsx010
Saigal, S. (2008). Measurement of quality of life of survivors of neonatal intensive care: critique and implications Sem. Perinatology, 32(1), 59-66.
Saugstad, O. D. (2016). The Newborn at the edge of viability. Acta Paediatr., 105(11), 1249-1251. DOI: http://doi.org/10.1111/apa.13564
Sayeed, S. A. (2005). Baby Doe Redux? The Department of Health and Human Services and the Born-Alive Infants Protection Act of 2002: A Cautionary Note on Normative Neonatal Practice. Pediatrics, 116, e576-e585. DOI: https://doi.org/10.1542/peds.2005-1590
Sorokin, P., Actis, A. M., & Outomuro, D. (2016). Comités de ética asistencial: de los grandes dilemas a los nuevos desafíos. Rev. Bioét, 24(1), 91-97. DOI: https://doi.org/10.1590/1983-80422016241110
Stenson, B. J. (2017). Highlights from this issue. Archives of Disease in Childhood - Fetal and Neonatal Edition, 102: F469. DOI: https://doi.org/10.1136/archdischild-2017-314224
United States. Health and Social Service Department. (1983). Propose Rules 45 CFR Part 84. Non-discriminations on the basis of handicap relating to health care for handicapped infants. [Internet]. Fed. Regist., 48(129), 30850. Disponible: http://bit.ly/1U1addK
Verhagen, E., & Sauer, P. J. J. (2005) End of life decisions in newborns: an approach from the Netherlands. Pediatrics, 116, 736-39. DOI: https://doi.org/10.1542/peds.2005-0014
Verhagen, E., & Sauer, P. J. J. (2005). The Groningen protocol: euthanasia in severely ill newborns. NEJM, 352, 959-62. DOI: https://doi.org/10.1056/NEJMp058026
Verhagen, E., van der Hoeven, M. A. H., van Meerveld, R. C., et al. (2007). Physician medical decision at the end of life in newborns: insight into implementation at 2 dutch centers. Pediatrics 120(1), e20-e28. DOI: http://doi.org/10.1542/peds.2006-2555
Downloads
Published
How to Cite
Issue
Section
License
The authors of articles published in Revista Iberoamericana de Bioética retain the intellectual property rights over their works and grant the journal their distribution and public communication rights, consenting to their publication under a Creative Commons Attribution-NonCommercial-NoDerivates 4.0 Internacional. Authors are encouraged to publish their work on the Internet (for example, on institutional or personal pages, repositories, etc.) respecting the conditions of this license and quoting appropriately the original source.
