Ethical dilemmas in decision making at limits of neonatal viability

Ali M Nadroo


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Survival rate for very preterm infants has improved over the last two decades. Although the incidence of such births is about 2%, the impact on these infants, their families, the healthcare providers, and society is profound. The birth of an extremely-low-birth-weight (ELBW) and early gestational age infant poses great challenges to the family and the health professionals with complex medical, social and ethical issues. There is an increased risk of chronic medical problems and disability  for the survivors. It is difficult to make decisions when trying to provide optimal medical care to the infant and support the family when delivery occurs at the threshold of viability because outcome at that time is highly unpredictable. Such decisions may leave lifelong impressions on those involved.

An individualized prognostic strategy appears to be the most appropriate approach. While keeping the patient's best interest as the primary objective, the goal is to reach, through a process of effective communication between the parents and physicians, a consensual decision that respects parents' wishes and promotes physician beneficence.

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