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Extreme Prematurity - Practices, Bioethics, And The Law Part 5

Đơn vị chăm sóc tích cực sơ sinh (NICU) đầu tiên tại Hoa Kỳ được khánh thành năm 1965 tại New Haven, Connecticut và năm 1975 Hội Nhi Khoa Hoa kỳ đã cấp Bằng về sơ sinh đầu tiên. | 23 UNITED STATES The first important U.S. report that related to the extremely preterm infant came from a president s commission published in 1983. 226 In the section on seriously ill newborns the commission reported that between 1970 and 1980 the neonatal mortality rate almost halved and that this was the greatest proportional decrease in any decade since national birth statistics were first recorded in 1915. The decrease was especially dramatic in the very low birth weight 1 500g and the extremely low birth weight 1 000g infants with 50 of the latter surviving at that time compared to less than 20 twenty years previously. However they noted that there was a downside to this as the survivors could be impaired. This they stated tested the limits of medical certainty in diagnosis and raises profound ethical issues. The commission attempted to provide ethical and legal guidelines in order to provide a framework for those in health care and the law. To aid them in this testimony was provided by various experts. One such testimony came from Carole Kennon a neonatal intensive care social worker who stated that anguished parents watching the suffering of an infant the size of an adult s 91 REPORTS OFFICIAL OPINIONS AND GUIDELINES hand - connected to awesome machinery and offered only distant prospects of a somewhat normal survival - inevitably takes an emotional toll and for those families who leave the unit with a handicapped child they must often travel a financially and emotionally perilous path. The commission also noted that withdrawing life support from a seriously impaired infant was a relatively frequent occurrence in U.S. neonatal intensive care units and this was usually following parent and physician agreement. But questioning of this system was reflected by the statement of parents Paul and Marlys Bridge that we regard any decision making by concerned physician and parents behind closed doors of the pediatric unit as a haphazard approach. 227 This sentiment .