Anemia of Prematurity - Portal Neonatal

These particular questions are at the root of what many healthcare professionals see as the
dilemmas in providing neonatal intensive care. These questions often are raised at bedside while
providing care, during teaching rounds, and during special ethics rounds held in the NICU.
However, these questions usually are asked in a more obscure manner, and the sequence of
questions is typically in the reverse order of their annotation above. Healthcare professionals often
hear, "Are we doing the right thing for this baby?" "What else can we do for this patient?" "Would
the infant be a candidate for this therapy or a different one?"
Amidst the flurry of activity in stabilizing the health of an infant or working through his or her
resuscitation, professionals from all disciplines involved in the care of a critically ill newborn may
wonder, "Why is this procedure being performed?" "Should this procedure stop?" "What do the
parents want?" "Does a better or more standard way of providing this care exist?"
Often, after hours or days of exhaustive efforts that still may result in neonatal death, clinicians may
wonder, "Why are we here?" "Did we make a difference?" "What are we trying to accomplish with
these efforts?"
These questions broach issues that are central to the clinician's perception of being a valued
person in the NICU environment while trying to serve patients, families, and a broader society. In
part, these questions reflect the values of the healthcare professions, the values of individuals, and
the values of patients and families. To ignore these questions is to fail to recognize the significant
influence these values have had in shaping individual professional lives and human interactions.
Beyond that, failing to answer these questions perpetuates an inability or unwillingness to
responsibly address the value-laden charge that comes with professing to be willing and able to
help a newborn who is vulnerable and sick, which is the charge to practice the art of medicine with
scientific rigor, technologic skill, and human caring, even in the face of medical uncertainty. Ignoring
these questions leads to moral uncertainty and, quite possibly, moral distress or angst stemming
from doing things against one's own better judgment. This article considers 3 questions that pertain
to some of the ethical issues raised in neonatal medicine. In the course of answering these 3
questions and discussing clinical ethics, ethics are defined as the applied philosophical study of
right actions or how healthcare professionals may struggle to do what is right or good for their
patients. These questions aim to address the ethical concerns raised by caring for critically ill
newborns.
"What are the goals of neonatal intensive care?"
As in other clinical paradigms, neonatal medicine requires a defined end or objective, which may be
presumed to be treating the newborn who is ill and/or curing any acute disease process that
impedes the normal physiologic transition toward healthy extrauterine life. But what are the more
global goals? Or, when the curative model is inadequate, what do the goals become?
"What place do guidelines have in the ethical practice of neonatal medicine and how should
they be developed?"
As neonatal medicine has been practiced in the United States and around the world, a number of
guidelines have emerged. The roles of authoritative statements, professional policies, and
recommendations lead to this question.
"What is good for critically ill newborns and who determines this?"
The presence of numerous voices in deliberations about newborn patient care presses this
question.