End of life
Yann Joly, Bartha Maria Knoppers in Routledge Handbook of Medical Law and Ethics, 2014
Neonatology specialises in treating newborns with diverse, life-threatening conditions. This can include full-term babies with multiple congenital disorders, babies who suffer from complications during delivery or extremely pre-term newborns (<26 weeks) hovering between life and death. In such cases, the spectrum of medical possibilities applied within the field of neonatology demands that positive and negative aspects of decisions, and their subsequent effects, are constantly weighed. On the one hand, it is possible to save lives and to treat children who would certainly have died in previous times. On the other hand, it remains to be asked whether life-sustaining treatment is justifiable if it will result in poor quality of life for the child (Walther 2005). In our ethical and legal exploration of these questions, we largely rely on the reports published by the Nuffield Council on Bioethics (2006), the Health Council of the Netherlands (2007) and the Committee on Fetus and Newborn of the American Academy of Pediatrics (2007, reaffirmed 2010).
Surgical Management of Placenta Accreta
Robert M. Silver in Placenta Accreta Syndrome, 2017
On the day of the scheduled delivery, a preoperative checklist (Figure 6.1) should be utilized to prepare the operating room and team. After induction of anesthesia, vascular catheters (embolization and balloon occlusion) can be placed. A staff member from institutional research (IR) or vascular should be readily available until completion of the surgery for management of the catheters. Blood products for possible massive transfusion should available in the operating room before starting the case. Cell saver technology and credentialed staff should be immediately available in the operating room prior to initiating the delivery. A neonatology team composed of a physician, nurses, and/or respiratory therapists should be present at all deliveries and a checklist to ensure preparedness for delivery should be used.
Use of C-Reactive Protein (CRP) and haematological score to predict positive blood cultures in sepsis
Cut Adeya Adella in Stem Cell Oncology, 2018
Patients were neonates admitted to the Neonatology Unit at Haji Adam Malik General Hospital, Medan, between April and August 2015. Neonates suspected of sepsis were examined, and had performed laboratory tests including complete blood count, IT ratio, IM ratio, PMN and degenerative PMN, CRP and blood culture. The laboratory results were then evaluated to calculate the score in the haematological scoring system. The score was then compared to the CRP value and against the blood culture results. Diagnosis of sepsis was made by physicians based on physical examination and laboratory results before blood culture results. Written informed consent was obtained from the parents or legal guardians. The study was approved by the Ethics Committee of the University of Sumatera Utara, Indonesia.
Racial Disparities in Preemies and Pandemics
Published in The American Journal of Bioethics, 2020
Marin Arnolds, Rupali Gandhi, Mobolaji Famuyide, Dalia Feltman
As COVID-19 related hospitalizations surged in other countries and began to rise sharply in the United States, hospitals, healthcare systems, and states began to grapple with the terrifying question of what to do if ventilators became scarce. Centers began to develop protocols to guide how scarce resources would, if necessary, be allocated among different patients. Extremely preterm infants continue to be born during the pandemic and require critical care resources, including ventilators (not because of COVID-19 but because of their immature organ systems). Haward and colleagues address the question of how these fragile newborns should factor into scarce resource allocation protocols (Haward et al. 2020). The authors address important realities commonly encountered by the neonatology community. Their compelling arguments for supporting the claims of extremely premature infants to continued ventilator provision within these protocols include: existing bias against extremely premature infants, the difficulty in predicting the outcome of a given extremely premature infant, and the absence of acceptable tools to compare long or short-term prognoses for an extremely preterm baby (“Judy”) against those of an adult (“Jim”). The authors rightly caution against the use of QALYs as potentially leading to ableist and ageist discrimination.
Decrease in Hospitalizations and Increase in Deaths during the Covid-19 Epidemic in a Pediatric Hospital, Yaounde-Cameroon and Prediction for the Coming Months
Published in Fetal and Pediatric Pathology, 2021
David Chelo, Isabelle Mekone Nkwelle, Félicitée Nguefack, Hubert Désiré Mbassi Awa, Dominique Enyama, Séraphin Nguefack, Diomède Noukeu Njinkui, Jocelyn Tony Nengom, Georges Nguefack-Tsague, Paul Olivier Koki Ndombo
The study took place in Yaounde, the political capital of Cameroon, at the Mother and Child Center of the Chantal Biya Foundation (MCC/CBF). This is a mother and child hospital dominated by the children's sector, which is the only one offering hospitalizations. The hospital has a capacity of 260 beds and 460 staff members made up of 65 doctors, 300 paramedics and about 100 support staff. The average annual attendance of the MCC/CBF was 34,600 over the past 4 years. Ash the authors if this is 88.7 and 87.5 percent, or average number of beds filled in 2018 and 2019. Patient’s care is continuous, day and night. Hospitalizations are carried out in departments each headed by a pediatrician assisted by general practitioners, pediatric residents and nurses. There are two neonatology services, one for term neonates and the other for premature babies. Infants and other children are admitted in eight specialized units (cardiology, endocrinology, nephrology, neurology, haemato-oncology, infectiology, sickle cell disease, gastroenterology). The center also has an intensive care unit. The staff on call is made up of two nurses in each unit and two doctors in the emergency service who are called upon to intervene in different units if need be. The entire organization of the hospital has remained unchanged and all departments have remained fully functional since the start of the pandemic. At the end of March 2020, a three-day training course was offered to the doctors of the hospital by infectious diseases specialists to empower them on the recognition of signs of SARS-Cov-2 infection.
Occupational Therapy Management Strategies for Infants With Neonatal Abstinence Syndrome: Scoping Review
Published in Occupational Therapy In Health Care, 2019
Samantha A Oostlander, Jillian A Falla, Kimberly Dow, Sandra Fucile
This scoping review aims to identify the non-pharmacologic interventions currently used in the treatment of infants with NAS that fall within the scope of the occupational therapy profession. The purpose is to provide health care professionals working in neonatology with information on available intervention strategies and help contribute to the professional development of current practicing occupational therapists in this highly specialized area. The Person-Environment-Occupation (PEO) model has been used as a framework to organize the results in order to promote understanding by grounding these results in occupational therapy theory (Law et al., 1996). The PEO model asserts that the components of person, environment and occupation are in a transactive relationship with each other and that optimal occupational performance can be achieved by altering any of the three components (Law et al., 1996).
Related Knowledge Centers
- Birth Defect
- Low Birth Weight
- Pulmonary Hypoplasia
- Preterm Birth
- Pediatrics
- Hospital
- Neonatal Intensive Care Unit
- Infant
- Intrauterine Growth Restriction
- Sepsis