Keywords
Fetal viability
Ethics
Premature newborns
Ethics
Premature newborns
How to Cite
Zamorano Jiménez, C. A., Chirino-Barceló, Y., Baptista González, H. A., & Altamirano Bustamante, M. (2013). Bioethics in real time: The limit of viability in newborn infants. Médicas UIS, 26(3). Retrieved from https://revistas.uis.edu.co/index.php/revistamedicasuis/article/view/3918
Abstract
Advances in perinatal medicine over the past decades have led to reduced rates in neonatal mortality with a gradual decrease in gestational age with chances of survival. The aim of this review is to analyze the elements considered in bioethical decision making to establish the limits of viability in the newborn infant. A literature search was conducted in diferent sources and electronic databases on diferent ethics, legal and humanitarian aspects in relation to the limit of neonatal viability. We describe two clinical scenarios, which are the platform to start the analysis of the ethical dilemma that determines the limit of viability. We discuss the “gray zone” of neonatology according to survival and mortality rates in diferent countries with distinctive characteristics, dividing them into developed and developing countries. Bioethical analysis is performed of the dilemma, based on ethical theories and models of judgment: utilitarian, deontological and aretological theories. (MÉD UIS.2013;26(3):23-31)
References
1. Fletcher J. The Ethics of Genetic Control: Ending Reproductive Roulette, Prometheus Books 1975: 218.
2. Vakrilova L, Stancheva B, Dimitrov A, Nikolov A. The very low birth weight and very low gestational age neonates--survival, prognosis and perspectives. Akush Ginekol (Sofiia) 2011; 50(1): 31-36.
3. Asunción Álvarez del Río, Patricia Greter. Aborto tardío y “eutanasia” en neonatos. En Foro Consultivo Científico y Tecnológico. Eutanasia: hacia una muerte digna. Colegio de Bioética A.C.; 2008. p61-77.
4. Walden M, Sala DJ. Controversies in the resuscitation of infants of borderline viability. AWHONNS Clin Issues Perinat Womens Health Nurs 1993; 4(4): 570-577.
5. Meadow WL, Lantos J. Epidemiology and ethics in the neonatal intensive care unit. Qual Manag Health Care 1999; 7(4): 21-31.
6. Candee D, Puka B. An analytic approach to resolving problems in medical ethics. J Med Ethics 1984; 10(2): 61-70.
7. Sulmasy, D. Dignity and Bioetchis: History, Theory, and Selected Applications. In Essays Commissioned by the President’s Council on Bioethics. Human dignity and Bioethics; Washington 2008. p 469-519
8. Garcia Pavon R. Principales teorias y criterios éticos de decisión. En:Myriam M. Altamirano Bustamante, Juan Garduño Espinosa, María del Carmen García Peña y Onofre Muñoz Hernández. Etica Clínica. Una perspectiva transfuncional. México: Editorial CORINTER; 2006. p 101-135.
9. Wood B, Katz V, Bose C, Goolsby R, Kraybill E. Survival and morbidity of extremely premature infants based on obstetric assessment of gestational age. Obstet Gynecol 1989; 74(6): 889-892.
10. Agustines LA, Lin YG, Rumney PJ, Lu MC, Bonebrake R, Asrat T, et al. Outcomes of extremely low-birth-weight infants between 500 and 750 g. Am J Obstet Gynecol 2000; 182(5): 1113-1116.
11. Hahn WH, Chang JY, Chang YS, Shim KS, Bae CW. Recent trends in neonatal mortality in very low birth weight Korean infants: in comparison with Japan and the USA. J Korean Med Sci 2011; 26(4): 467-473.
12. Yu HJ, Kim ES, Kim JK, Yoo HS, Ahn SY, Chang YS, et al. Outcomes of small for gestational age micropremies depending on how young or how small they are. Korean J Pediatr 2011; 54(6): 246-252.
13. Moriette G, Rameix S, Azria E, Fournié A, Andrini P, Caeymaex L, et al. Very premature births: Dilemmas and management. Part 1. Outcome of infants born before 28 weeks of postmenstrual age, and definition of a gray zone. Arch Pediatr 2010; 17(5): 518-526.
14. Moriette G, Rameix S, Azria E, Fournié A, Andrini P, Caeymaex L, et al. Very premature births: Dilemmas and management. Second part: Ethical aspects and recommendations. Arch Pediatr 2010. 17(5): 527-539.
15. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126(3): 443-456.
16. Nankabirwa V, Tumwine JK, Tylleskär T, Nankunda J, Sommerfelt H. Perinatal mortality in eastern Uganda: a community based prospective cohort study. PLoS One 2011; 6(5): e19674.
17. Página del INEGI en Internet (www.inegi.org.mx).
18. Montiel Vazquez JF, Cardona Pérez JA, Cullen Benitez PJ, Arizmendi Dorantes JG. Mortalidad, morbilidad y limite de viabilidad de los recien nacidos de muy bajo peso en el Hospital Angeles Lomas. Acta Médica Grupo Angeles 2011; 9(4): 186-191.
19. Orzalesi M, Cuttini M. “Ethical issues in neonatal intensive care.” Ann Ist Super Sanita 2011; 47(3): 273-277.
20. Cuttini M, Kaminski M, Saracci R, de Vonderweid U. “The EURONIC Project: a European concerted action on information to parents and ethical decision-making in neonatal intensive care.” Paediatr Perinat Epidemiol 1997; 11(4): 461-474.
21. Cuttini M, Nadai M, Kaminski M, Hansen G, de Leeuw R, Lenoir S, et al. “End-of-life decisions in neonatal intensive care: physicians’ self-reported practices in seven European countries. EURONIC Study Group.” Lancet 2000; 355(9221): 2112-2118.
22. Cuttini M, Casotto V, de Vonderweid U, Garel M, Kollée LA, Saracci R; EURONIC Study Group. “Neonatal end-of-life decisions and bioethical perspectives.” Early Hum Dev 2009; 85(10 Suppl): S21-25.
23. Bilgen H, Topuzoğlu A, Kuşçu K, Altuncu E, Ozek E. “End-of-life decisions in the newborn period: attitudes and practices of doctors and nurses.” Turk J Pediatr 2009; 51(3): 248-256.
24. Costeloe KL, Hennessy EM, Haider S, Stacey F, Marlow N, Draper ES. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ. 2012;345:e7976.
25. Moore T, Hennessy EM, Myles J, Johnson SJ, Draper ES, Costeloe KL, Marlow N. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ. 2012;345:e7961.
26. EXPRESS Group, Fellman V, Hellström-Westas L, Norman M, Westgren M, Källén K, Lagercrantz H, Marsál K, Serenius F, Wennergren M. One-year survival of extremely preterm infants after active perinatal care in Sweden. JAMA. 2009 (3);301(21):2225-33.
27. Helderman JB, O’Shea TM, Kuban KC, Allred EN, Hecht JL, Dammann O, Paneth N, McElrath TF, Onderdonk A, Leviton A; ELGAN study Investigators. Antenatal antecedents of cognitive impairment at 24 months in extremely low gestational age newborns. Pediatrics. 2012;129(3):494-502.
28. Cookson R, McCabe C, Tsuchiya A. “Public healthcare resource allocation and the Rule of Rescue.” J Med Ethics 2008; 34(7): 540-544.
29. McKie J, Richardson J. “The rule of rescue.” Soc Sci Med 2003; 56(12): 2407-2419.
30. Zlotnik Shaul R, Vitale D. “Can we afford it?: ethical consideration of expensive drug treatment for neonates and infants.” Clin Pharmacol Ther 2009; 86(6): 587-589.
31. Blinderman C. “Palliative care, public health and justice: setting priorities in resource poor countries.” Dev World Bioeth 2009; 9(3): 105-110.
2. Vakrilova L, Stancheva B, Dimitrov A, Nikolov A. The very low birth weight and very low gestational age neonates--survival, prognosis and perspectives. Akush Ginekol (Sofiia) 2011; 50(1): 31-36.
3. Asunción Álvarez del Río, Patricia Greter. Aborto tardío y “eutanasia” en neonatos. En Foro Consultivo Científico y Tecnológico. Eutanasia: hacia una muerte digna. Colegio de Bioética A.C.; 2008. p61-77.
4. Walden M, Sala DJ. Controversies in the resuscitation of infants of borderline viability. AWHONNS Clin Issues Perinat Womens Health Nurs 1993; 4(4): 570-577.
5. Meadow WL, Lantos J. Epidemiology and ethics in the neonatal intensive care unit. Qual Manag Health Care 1999; 7(4): 21-31.
6. Candee D, Puka B. An analytic approach to resolving problems in medical ethics. J Med Ethics 1984; 10(2): 61-70.
7. Sulmasy, D. Dignity and Bioetchis: History, Theory, and Selected Applications. In Essays Commissioned by the President’s Council on Bioethics. Human dignity and Bioethics; Washington 2008. p 469-519
8. Garcia Pavon R. Principales teorias y criterios éticos de decisión. En:Myriam M. Altamirano Bustamante, Juan Garduño Espinosa, María del Carmen García Peña y Onofre Muñoz Hernández. Etica Clínica. Una perspectiva transfuncional. México: Editorial CORINTER; 2006. p 101-135.
9. Wood B, Katz V, Bose C, Goolsby R, Kraybill E. Survival and morbidity of extremely premature infants based on obstetric assessment of gestational age. Obstet Gynecol 1989; 74(6): 889-892.
10. Agustines LA, Lin YG, Rumney PJ, Lu MC, Bonebrake R, Asrat T, et al. Outcomes of extremely low-birth-weight infants between 500 and 750 g. Am J Obstet Gynecol 2000; 182(5): 1113-1116.
11. Hahn WH, Chang JY, Chang YS, Shim KS, Bae CW. Recent trends in neonatal mortality in very low birth weight Korean infants: in comparison with Japan and the USA. J Korean Med Sci 2011; 26(4): 467-473.
12. Yu HJ, Kim ES, Kim JK, Yoo HS, Ahn SY, Chang YS, et al. Outcomes of small for gestational age micropremies depending on how young or how small they are. Korean J Pediatr 2011; 54(6): 246-252.
13. Moriette G, Rameix S, Azria E, Fournié A, Andrini P, Caeymaex L, et al. Very premature births: Dilemmas and management. Part 1. Outcome of infants born before 28 weeks of postmenstrual age, and definition of a gray zone. Arch Pediatr 2010; 17(5): 518-526.
14. Moriette G, Rameix S, Azria E, Fournié A, Andrini P, Caeymaex L, et al. Very premature births: Dilemmas and management. Second part: Ethical aspects and recommendations. Arch Pediatr 2010. 17(5): 527-539.
15. Stoll BJ, Hansen NI, Bell EF, Shankaran S, Laptook AR, Walsh MC, et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics 2010; 126(3): 443-456.
16. Nankabirwa V, Tumwine JK, Tylleskär T, Nankunda J, Sommerfelt H. Perinatal mortality in eastern Uganda: a community based prospective cohort study. PLoS One 2011; 6(5): e19674.
17. Página del INEGI en Internet (www.inegi.org.mx).
18. Montiel Vazquez JF, Cardona Pérez JA, Cullen Benitez PJ, Arizmendi Dorantes JG. Mortalidad, morbilidad y limite de viabilidad de los recien nacidos de muy bajo peso en el Hospital Angeles Lomas. Acta Médica Grupo Angeles 2011; 9(4): 186-191.
19. Orzalesi M, Cuttini M. “Ethical issues in neonatal intensive care.” Ann Ist Super Sanita 2011; 47(3): 273-277.
20. Cuttini M, Kaminski M, Saracci R, de Vonderweid U. “The EURONIC Project: a European concerted action on information to parents and ethical decision-making in neonatal intensive care.” Paediatr Perinat Epidemiol 1997; 11(4): 461-474.
21. Cuttini M, Nadai M, Kaminski M, Hansen G, de Leeuw R, Lenoir S, et al. “End-of-life decisions in neonatal intensive care: physicians’ self-reported practices in seven European countries. EURONIC Study Group.” Lancet 2000; 355(9221): 2112-2118.
22. Cuttini M, Casotto V, de Vonderweid U, Garel M, Kollée LA, Saracci R; EURONIC Study Group. “Neonatal end-of-life decisions and bioethical perspectives.” Early Hum Dev 2009; 85(10 Suppl): S21-25.
23. Bilgen H, Topuzoğlu A, Kuşçu K, Altuncu E, Ozek E. “End-of-life decisions in the newborn period: attitudes and practices of doctors and nurses.” Turk J Pediatr 2009; 51(3): 248-256.
24. Costeloe KL, Hennessy EM, Haider S, Stacey F, Marlow N, Draper ES. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ. 2012;345:e7976.
25. Moore T, Hennessy EM, Myles J, Johnson SJ, Draper ES, Costeloe KL, Marlow N. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ. 2012;345:e7961.
26. EXPRESS Group, Fellman V, Hellström-Westas L, Norman M, Westgren M, Källén K, Lagercrantz H, Marsál K, Serenius F, Wennergren M. One-year survival of extremely preterm infants after active perinatal care in Sweden. JAMA. 2009 (3);301(21):2225-33.
27. Helderman JB, O’Shea TM, Kuban KC, Allred EN, Hecht JL, Dammann O, Paneth N, McElrath TF, Onderdonk A, Leviton A; ELGAN study Investigators. Antenatal antecedents of cognitive impairment at 24 months in extremely low gestational age newborns. Pediatrics. 2012;129(3):494-502.
28. Cookson R, McCabe C, Tsuchiya A. “Public healthcare resource allocation and the Rule of Rescue.” J Med Ethics 2008; 34(7): 540-544.
29. McKie J, Richardson J. “The rule of rescue.” Soc Sci Med 2003; 56(12): 2407-2419.
30. Zlotnik Shaul R, Vitale D. “Can we afford it?: ethical consideration of expensive drug treatment for neonates and infants.” Clin Pharmacol Ther 2009; 86(6): 587-589.
31. Blinderman C. “Palliative care, public health and justice: setting priorities in resource poor countries.” Dev World Bioeth 2009; 9(3): 105-110.
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