Neonatal Ethics

Amy Allan, Holly Nolan, Blossum

Xiong
Neonatology

● Subspecialty of pediatrics
○ Specifically newborn infants (premature)
● 14 years of schooling required
○ 4 years of undergraduate school
○ 4 years of medical school
○ Pediatric residency
○ Neonatal fellowship
Neonatology ● Salary: $197,700 (mean)
○ Avg. retirement age: 63
● Pros: $, career satisfaction
● Cons: Years of schooling, schedule
not flexible
 ● Neonatal- first 28 days of life
Neonatal ● Special section of the hospital
○ Separate from healthy baby nursery
Intensive Care ○ Still close to mothers
Unit (NICU) ● For babies who need round the clock care
due to complications and problems like:
○ Assisted breathing
○ Underdeveloped body systems
(immune system, brain, etc…)
● Admitted from delivery room, newborn
nursery, or other hospital’s NICU
Who Needs Special ● Babies born under 37 weeks or
over 42 weeks
Care? ● Low birth weight (under 5.5 lbs)
● Medical condition
○ Heart problems
○ Infections
○ Birth defects
Beginning and Advancements

● Dr. Joseph DeLee ● Certification for neonatology

○ 1896 ○ 1975
○ First incubator ○ American Board of
○ Chicago, Illinois Pediatrics
● Treatment of PPHN
● First NICU
○ Persistent pulmonary
○ 1965
hypertension
○ First NICU in American
○ Government grant
hospitals
● Further treatment of NEC
○ New Haven, Connecticut
○ Necrotizing enterocolitis
○ Government grant
Where? Why?

● Globally ● Saving babies up to 22 - 23

○ United States weeks
○ Europe ○ 5,000 born annually in
○ Asia United States
● Factors ○ Slim chances with varying
○ Cost birth factors
○ Access/Location ○ 50/50 problems
○ Availability ● Giving newborns a fighting
chance
● Varies in different hospitals
Gestational vs. ● Gestational : last normal
menstrual period-birth

Fetal Age ○ Used to describe where a

baby is (devel.)
● Fetal : conception-birth
○ actual age of growing fetus
(approx. 2 weeks younger)
Age and ● Week 21-22: stomach able to
absorb nutrients (mostly

Development placenta), skin more opaque and

beginning of hair
● Week 23-29: brain cells,
movement, bowel movement,
eyes, active, sleep
● Week 30: gaining body weight,
most body functions developed
● Week 32: organs developed
(lungs)
● Week 31-38: growing, fetal
position, preparing for birth
Premature ● History:
○ Before a baby was considered

Criteria premature solely on a low

birth weight
● Modern times:
○ Anything before a full term
birth (38-42 wks.)
● Spectrum
○ Less than 28 weeks:
extremely preterm (<6%)
○ 28-31 weeks: very preterm
○ 32-36 weeks: moderately
preterm
Survival Rate?
● Before 28 weeks and
6 days
○ 80% survival
○ Down 10% for
every week
before 28
● Between 29 - 32
weeks and 6 days
○ 95%
○ Breathing
difficulties
● Above 33 weeks
○ 99% or more
The
Problem
Physicians vs. Parents- the decision
Ethical
● Who can receive this care? (LDC
vs MDC) ($$$)
● If it is experimental (not been tried

Questions ●
before) is it still okay?
Is a baby ever too far gone or too
sick?
The Law ● Gray area
○ Physician v. Parents- who
controls future of baby in
complicated situations
● Factors to consider:
○ Choice affects parents
■ They are long-term
caretakers
○ Child suffering
○ Chances of survival
● Stipulations/who is to blame?
Baby Doe #1
● Born 1982
● Born with down syndrome and a
tracheal-oseophageal fistula
○ What is a fistula?
● Parents told surgeon not to fix
fistula
● Died of starvation and
dehydration
Baby Doe amendment formed from
this case
Baby Doe #2
● Born with severe
meningomyelocele
○ What is meningomyelocele
● Parents and physician decided to
not provide treatment
● Died of dehydration
 ● A federal law signed in 1984

Baby Doe ● Prevents “withholding of medically

Amendment
indicated treatment from disabled
infants with life-threatening
conditions.”
● “Does not include failure to
provide treatment…when…such
treatment would prolong dying, not
be effective…be futile in terms of
survival…be virtually futile…and
treatment itself…would be
inhumane.”
Moral Code ● Quality of life
○ Lifelong effects
○ Ties to abortion laws
○ Who gets to live and who
does not
Religious ● Most people in religious groups
are pro-life

Beliefs ○ Generalized idea, some may

disagree
○ Seen as murder
Societal Impact ●
●
Population statistics
Long term care with parents

& Future ● Medical - therapy,

treatments/medications
Implications ● Education - Where does the money
come from?
○ Teacher aids
○ Programs
● Adulthood
○ Occupation
○ Where to live
○ Support
Disability ● Correlation between earlier birth
and possible disabilities

Statistics ○ Developmental
○ Cognitive
Financial Costs ●
●
Average stay is 2 weeks
Admission to the NICU = $76,000

of NICU ●
○ What are admissions?
Charges = $280,000
○ What are charges?
● U.S. alone = $26.2 billion
 ● Look into possible coverage with

How to Cope your insurance

○ Add your child onto the
With Financial insurance if you have not
already done so
Costs ● Contact a social worker
○ Can help you find financial aid
for NICU costs
● Apply for financial aid
○ Medicaid
○ Supplemental Security
Income Program (SSI)
● Payment plans
○ Contact the hospital’s finance
department
 Pros/Cons/ ● Pros: Scenario #1
○ Baby lives

Risks/ Possible ○ It would be as a result of the

parents’ decision

Outcomes ● Cons: Scenario #2

○ Birth defects
○ Mental disabilities
Scenario:
○ Costs
If the baby is in distress and in ○ Overall quality of life
between receiving care or dying
Preventative ● Early education and formation

Measures
Discussion ● What do you think about taking
extreme measures for premature

Questions babies?
○ Do you think that it is worth
the possible consequences?
○ Should laws define the final
decision or should they by
based off of case by case?
○ Why have laws not been
created regarding extremely
preterm births?
Any Questions?