Search PubMed⌕ Search
Home/Archive/PubMed

PubMed · 14673225

[Ethical problems regarding extremely preterm infants].

H U Bucher
View original source ↗Export metadata ↓

Abstract

In the industrialized countries during the last 20 years, ever smaller preterm infants have been re-animated after birth, subjected to mechanical ventilation, fed parenterally and treated with various drugs. The smaller and more premature the infant, the longer the intensive care, the greater pain and suffering for the infants concerned and the worse the long-term results. Although mortality decreased, chronic problems of the lungs, eyes and brain (cerebral palsy) increased in the surviving infants. Therefore specialists as well as the general public began to discuss the limits of using intensive medicine. Investigations among neonatologists and nursing staff all over Europe resulted in a wide spectrum of opinions where the line should be drawn, e.g. concerning gestational age. A majority is however in favour of stopping intensive care measures when these are not in the best interest of the infant, i.e. when treatment becomes painful and inescapable death is only postponed. In order to reach such a difficult medico-ethical decision in a structured, understandable and well-supported way, special procedures were developed, which have stood their test in practice.

Explore related subjects

Apgar ScoreAttitude of Health PersonnelCerebral PalsyCritical CareEthics, MedicalGestational AgeHumansInfant MortalityInfant, NewbornInfant, PrematureInfant, Premature, DiseasesPalliative CareParentsRisk FactorsSurveys and QuestionnairesComparative StudyEnglish AbstractJournal Article

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

H U Bucher. 2004. [Ethical problems regarding extremely preterm infants].. https://doi.org/10.1159/000074314

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2006

Strict guideline reduces the need for RBC transfusions in premature infants.

The aim of this study was to verify if the adoption of a strict guideline would reduce the need for red blood cell transfusions in the first 28 days of life in very low birth weight preterm infants. Retrospective study of two cohorts of very low birth weight infants transfused according to neonatologist decision (Period 1) or according to a strict guideline for erythrocytes transfusion (Period 2). Clinical and hematological data of 80 premature infants transfused in both periods of the study were obtained by chart review. During the first 28 days of life, 45 (62.5%) of 72 premature infants born in the Period 1, and 44 (55.7%) of 79 newborns born in Period 2 received at least one erythrocyte transfusion; p = 0.40. Among patients transfused, the median number of transfusions was four per infant transfused (range: 1-13; mean: 4.6 +/- 3.2) in Period 1 and 3 (range: 1-18; mean: 4.0 +/- 3.5) in Period 2; p = 0.26. The median volume of erythrocytes administered per infant transfused in Period 1 was 40 ml kg(-1) (range: 10-170; mean: 48.8 +/- 38.3) and in Period 2 was 30 ml kg(-1) (range: 10-225; mean: 43.4 +/- 40.4), p = 0.41. Multiple linear regression analysis, after adjusting for birth weight, clinical risk index for babies, blood loss and days of ventilation, showed that the adoption of the strict guideline reduced the volume of erythrocytes transfused in 15.91 ml kg(-1) per infant transfused (95% CI: -24.69-7.14) p < 0.001. The adoption of a strict guideline reduced the need for red blood cells transfusions in very low birth weight infants.

Apgar Score↗
PubMed2006

Revalidation of the Score for Neonatal Acute Physiology in the Vermont Oxford Network.

OBJECTIVES: Our specific objectives were (1) to document the performance of the revised Score for Neonatal Acute Physiology and the revised Score for Neonatal Acute Physiology Perinatal Extension in predicting death in the Vermont Oxford Network, compared with published normative values; (2) to determine whether this performance could be improved through recalibration of the weights for individual score items; (3) to determine the impact of including congenital anomalies in the predictive model; and (4) to compare performance against that of the Vermont Oxford Network risk adjustment, separately and in combination. METHODS: Fifty-eight Vermont Oxford Network centers collected data prospectively for the revised Score for Neonatal Acute Physiology in the first 12 hours after admission of infants in 2002. RESULTS: Data were collected for 10,469 infants, and analyses were undertaken for 9897 who met inclusion criteria. The median revised Score for Neonatal Acute Physiology was 5, and the mean birth weight was 1951 g. Recalibration of the revised Score for Neonatal Acute Physiology and revised Score for Neonatal Acute Physiology Perinatal Extension resulted in minimal changes in their discriminatory abilities. The Vermont Oxford Network risk adjustment performed similarly, compared with the revised Score for Neonatal Acute Physiology Perinatal Extension. CONCLUSIONS: Current score performance was similar to that observed previously, which suggests that the revised Score for Neonatal Acute Physiology and revised Score for Neonatal Acute Physiology Perinatal Extension have not decalibrated over the 7 years since the first cohort was assembled, despite advances in neonatal care during that period. Addition of congenital anomalies to the revised Score for Neonatal Acute Physiology Perinatal Extension improved discrimination significantly, particularly for infants with birth weights of >1500 g. The Vermont Oxford Network risk adjustment performed similarly, compared with the revised Score for Neonatal Acute Physiology Perinatal Extension.

Apgar Score↗
PubMed2006

Factors associated with immunoprophylaxis failure against vertical transmission of hepatitis B virus.

In spite of adequate immunoprophylaxis, perinatal transmission of hepatitis B virus (HBV) has not been completely eliminated. This study evaluated the factors associated with the failure of HBV immunoprophylaxis. The study participants were 144 children who were born to HBsAg-seropositive mothers of known HBeAg status and they had received HB immune globulin and HB vaccine within 24 hours after birth followed by two further administrations of HB vaccine as recommended. Seventeen of the children (11.8%) suffered immunoprophylaxis failure, defined by HBsAg-seropositivity. The rate of HBV immunoprophylaxis failure was 12%, 0%, 21%, 0%, and 27% among the children born to HBsAg-seropositive, HBeAg-seronegative, HBeAg-seropositive, undetectable HBV DNA, and detectable HBV DNA mothers, respectively. The failure of HBV immunoprophylaxis was significantly associated with maternal HBeAg-seropositivity and HBV DNA seropositivity. To identify those children at high risk of HBV immunoprophylaxis failure, maternal HBeAg and HBV DNA need to be assessed prior to childbirth.

Apgar Score↗