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Ethical issues in Nicu

Jing Liu, Xin-Xin Chen, Xin-Ling Wang
On one hand, advances in neonatal care and rescue technology allow for the healthy survival or prolonged survival time of critically ill newborns who, in the past, would have been non-viable. On the other hand, many of the surviving critically ill infants have serious long-term disabilities. If an infant eventually cannot survive or is likely to suffer severe disability after surviving, ethical issues in the treatment process are inevitable, and this problem arises not only in developed countries but is also becoming increasingly prominent in developing countries...
2016: Journal of Maternal-fetal & Neonatal Medicine
Armand H Matheny Antommaria, Christopher A Collura, Ryan M Antiel, John D Lantos
A central principle of justice is that similar cases should be decided in similar ways. In pediatrics, however, there are cases in which 2 infants have similar diagnoses and prognoses, but their parents request different treatments. In this Ethics Rounds, we present such a situation that occurred in a single NICU. Three physician-ethicists analyze the issues.
May 2015: Pediatrics
Hafiz Muhammad Aslam, Shafaq Saleem, Rafia Afzal, Umair Iqbal, Sehrish Muhammad Saleem, Muhammad Waqas Abid Shaikh, Nazish Shahid
BACKGROUND: Birth asphyxia is an insult to the fetus or newborn due to failure to breath or breathing poorly, leads to decrease oxygen perfusion to various organs. According to WHO, 4 million neonatal deaths occurred each year due to birth asphyxia. Our goal was to evaluate antepartum, intrapartum, and fetal risk factors of birth asphyxia. METHODS: It was a Retrospective Case control study, conducted at Neonatal Intensive Care Unit of pediatric ward (I, II, III) and in Gynecology wards (I, II, III) of Civil Hospital Karachi, Dow University of Health Sciences...
2014: Italian Journal of Pediatrics
Janet Green, Philip Darbyshire, Anne Adams, Debra Jackson
BACKGROUND: Improved techniques and life sustaining technology in the neonatal intensive care unit have resulted in an increased probability of survival for extremely premature babies. The by-product of the aggressive treatment is iatrogenic pain, and this infliction of pain can be a cause of suffering and distress for both baby and nurse. RESEARCH QUESTION: The research sought to explore the caregiving dilemmas of neonatal nurses when caring for extremely premature babies...
March 2016: Nursing Ethics
Carmen Lúcia Guimarães de Aymar, Sônia Bechara Coutinho
The purpose of this paper was to carry out a review of literature on the history and current stage of the knowledge of systemic analgesia in neonatology and the factors influencing its use. A search for scientific articles was made in the MEDLINE, SciELO and LILACS databases using the keywords: analgesia, systemic analgesics, pain, neonatology, newborn, intensive care units and neonatal intensive care units. Additional research was made on dissertations and thesis databanks as well as text books. Literature consulted disclosed that, in general, analgesia is not a routine practice in neonatal intensive care units, despite the numerous studies demonstrating its importance...
December 2008: Revista Brasileira de Terapia Intensiva
Joke M Wielenga, Lyvonne N Tume, Jos M Latour, Agnes van den Hoogen
OBJECTIVE: This study aimed to identify and prioritise neonatal intensive care nursing research topics across Europe using an e-Delphi technique. DESIGN: An e-Delphi technique with three questionnaire rounds was performed. Qualitative responses of round one were analysed by content analysis and research statements were generated to be ranged on importance on a scale of 1-6 (not important to most important). SETTING: Neonatal intensive care units (NICUs) in 17 European countries...
January 2015: Archives of Disease in Childhood. Fetal and Neonatal Edition
Frederic Legrand, Rym Boulkedid, Valery Elie, Stephanie Leroux, Elizabeth Valls, Adolfo Valls-i-Soler, Johannes N Van den Anker, Evelyne Jacqz-Aigrain
BACKGROUND: Neonatal trials remain difficult to conduct for several reasons: in particular the need for study sites to have an existing infrastructure in place, with trained investigators and validated quality procedures to ensure good clinical, laboratory practices and a respect for high ethical standards. The objective of this work was to identify the major criteria considered necessary for selecting neonatal intensive care units that are able to perform drug evaluations competently...
2014: PloS One
Mary S Webb, Denise Passmore, Genieveve Cline, Denise Maguire
BACKGROUND: Currently preterm births are the leading causes of newborn deaths and newborn mortality in developed countries. Infants born prematurely remain vulnerable to many acute complications and long-term disabilities. There is a growing concern surrounding the moral and ethical implications of the complex and technological care being provided to extremely low birth weight infants in neonatal intensive care units in the developed nations. RESEARCH PURPOSE: The purpose of this study was to describe the ethical and moral issues that neonatal intensive care nurses experience when caring for low birth weight preterm infants and their families...
September 2014: Nursing Ethics
A Béranger, P Boize, M-L Viallard
INTRODUCTION: Prematurity is one of the etiologies for severe neurological complications. Decisions to withdraw therapeutics, including artificial nutrition and hydration (ANH), are sometimes discussed. But can one withdraw ANH if the patient is a child suffering from severe neurological conditions, based on his best interests? The aim of this study was to further the understanding of the complexity of the withdrawal of ANH and its implementation in the neonatal intensive care unit (NICU)...
February 2014: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Denise Maguire, Mary Webb, Denise Passmore, Genieveve Cline
PURPOSE: The primary aim of this qualitative methods study was to describe the lived experiences of neonatal intensive care unit (NICU) nurses with ethical and morally challenging issues. SUBJECTS: The target population for the study was registered nurses working in the NICU. Interviews were completed with 16 nurses from 1 hospital. DESIGN: A phenomenological method design was used to describe NICU nurses' lived experiences with ethical and moral issues encountered in the NICU...
October 2012: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Laura Cuzzolin, Roberto Antonucci, Vassilios Fanos
Neonates can perceive pain, therefore an adequate analgesic therapy is a major issue not only from an ethical perspective but also to improve short- and long-term outcome. Fever during the neonatal period requires hospitalization and needs a treatment with an antipyretic agent because of the high risk of severe complications. Paracetamol (acetaminophen), the most commonly prescribed drug in paediatric patients for its analgesic and antipyretic effects, is the only agent recommended for use as an antipyretic in the newborn and has been recently proposed as a supplement therapy to opioids for postoperative analgesia...
February 2013: Current Drug Metabolism
Hercília Guimarães, Gustavo Rocha, Carlo Bellieni, Giuseppe Buonocore
Advances in perinatal medicine have dramatically improved neonatal survival. End-of-life decision making for newborns with adverse prognosis is an ethical challenge and the ethical issues are controversial. The newborn is a person with specific rights which he cannot claim, due to his physical and mental immaturity. These rights impose to the society obligations and responsibilities, which health professionals and institutions of all countries must enforce. Every newborn has the right to life with dignity. Providing compassionate family-centered end-of-life care to infants and their families in the NICU should be a mandatory component of an optimally neonatal palliative care...
April 2012: Journal of Maternal-fetal & Neonatal Medicine
Tanya Sudia-Robinson
Ethical issues in perinatal and NICU settings can arise from a variety of situations. This article focuses on issues surrounding viability and the incorporation of advance directives and family-centered care. Prenatal education about infant viability, probable scenarios, and parental involvement in decision-making are addressed. Considerations for advance directives for complex births and critical decisions at the time of birth are also discussed. Implications for nurses and suggested dialogue strategies are provided...
May 2011: MCN. the American Journal of Maternal Child Nursing
Marina Cuttini, Veronica Casotto, Umberto de Vonderweid, Micheline Garel, Louis A Kollée, Rodolfo Saracci
In the nineties the EURONIC project documented the staff views and practices regarding ethical decision-making in neonatal intensive care units of eight Western Europe countries: France, Germany, Great Britain, Italy, Luxembourg, Netherlands, Spain and Sweden. This paper reviews the changes occurred in the ethical and legal background of these countries, and discusses possible influences on neonatal care practices. To a certain extent, many of these changes appear to be in line with the neonatal physicians' views and attitudes previously documented by the EURONIC project, while some are not...
October 2009: Early Human Development
Ingrid Miljeteig, Sadath Ali Sayeed, Amar Jesani, Kjell Arne Johansson, Ole Frithjof Norheim
OBJECTIVE: The aim of this article was to describe how providers in an Indian NICU reach life-or-death treatment decisions. METHODS: Qualitative in-depth interviews, field observations, and document analysis were conducted at an Indian nonprofit private tertiary institution that provided advanced neonatal care under conditions of resource scarcity. RESULTS: Compared with American and European units with similar technical capabilities, the unit studied maintained a much higher threshold for treatment initiation and continuation (range: 28-32 completed gestational weeks)...
August 2009: Pediatrics
Liv Fegran, Sølvi Helseth
AIM AND BACKGROUND: Family-centred care, which acknowledges parents as partners in care, is a desirable and essential part of neonatal nursing. There has been extensive research on parents' experiences of parenting in neonatal intensive care units (NICU), but there is little research on nurses' experiences of being in these enduring close relationships. The aim of this paper is to explore parents' and nurses' experiences of the close parent-nurse relationship when a premature child is hospitalized...
December 2009: Scandinavian Journal of Caring Sciences
E B Eason, R J Castriotta, V Gremillion, J W Sparks
OBJECTIVE: Since the enactment of the Texas Advance Directives Act of 1999, the Memorial Hermann Hospital Medical Appropriateness Review Committee (MARC) MARC reviewed six cases of children in the first year of life, three from the Neonatal ICU and three from the Pediatric ICU. We aimed to describe the characteristics of these patients and the role of the MARC in this process. STUDY DESIGN: A single reviewer retrospectively reviewed the cases for patient diagnoses, demographics, related ethical issues and the actions of the MARC...
September 2008: Journal of Perinatology: Official Journal of the California Perinatal Association
Judith Schroeder
Evidence suggests that NICU (neonatal intensive care unit) parents with an baby born at the threshold of viability do not always receive sufficient counselling during an emergency admission and as a consequence, are not well-informed to accept withdrawal of treatment or quality of life decisions. As prospective parents are not educated earlier in pregnancy about extreme premature delivery, crucial information and counselling explaining neonatal issues is only offered to labouring women during their emergency admission...
May 2008: Journal of Paediatrics and Child Health
Susan Rogers, Amani Babgi, Carlos Gomez
PURPOSE: This study was conducted to assess whether neonatal nurses who care for dying infants could be assisted in their knowledge and comfort via an educational intervention provided by hospital ethics committee members and hospice specialists. PARTICIPANTS: Eighty-two registered nurses working in a level III neonatal intensive care unit (NICU) were included. METHODS AND DESIGN: This was a quantitative pretest, intervention, post-test design with a single group undergoing educational sessions in the 6 areas of pain management, symptom management, ethical/legal issues, communication/culture, spiritual/anxiety, and prevention of compassion fatigue...
February 2008: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Brian Scott Carter, Scott Osborn Guthrie
BACKGROUND: A monthly neonatal intensive care unit (NICU) morbidity and mortality conference (M&MC) was used to study the documentation of end-of-life (EOL) care, and integrate related education for staff and trainees. OBJECTIVE: To study the current documentation of comprehensive, interdisciplinary, palliative EOL care in the NICU at the Vanderbilt Children's Hospital and improve it relative to a historical background. DESIGN/METHODS: A survey tool was developed and used at all neonatal M&MCs for 1 year (August 2003 through July 2004), in conducting a prospective chart audit of 50% of NICU deaths...
April 2007: Journal of Palliative Medicine
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