Neonatal ICU Issues:
Case 1 Discussion
This gestational age and estimated birthweight represent the "gray zone" in terms of viability vs. non-viability. Accordingly, the parents have a choice to make. They can choose a passive comfort care mode treatment (with non-survival being a virtual certainty) or alternatively, assisted ventilation, pressors, antibiotics, parenteral nutrition, etc. The role of the physician is to provide information and guide the parents through the decision-making process.
This situation 30 years ago would have presented no ethical dilemma. Indeed, the 1972 Roe v. Wade Supreme Court case defined the limit of viability as 28 weeks gestation. Any form of aggressive care involving newborn infants below this gestational was thought to be futile. Today, however, aggressive measures at birth are sometimes initiated with a modest degree of success achieved in terms of promoting survival (+/-25%). Notably, survival is accompanied by a long stay in the hospital following delivery (3-4 months), enormous costs(+/-$250,000), considerable suffering, and morbidity (in at least 50% of the cases there is significant handicap).
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