Clinical Concepts of Futility and Ethically Justified Limits on Neonatal Care: A Case Presentation of an Infant with Apgar Scores of 0 at 1, 5, and 10 Minutes

ABSTRACT

Appropriate length of delivery room resuscitative efforts for infants born without signs of life is controversial. We present the case of a preterm infant with Apgar scores of 0 at 1, 5, and 10 minutes but with a recovered heartbeat at 15 minutes. Using the clinically relevant conceptions of the principle of futility, we examine the ethical justification for the successive decisions to initiate, continue, and ultimately limit care for this patient. This difficult case highlights the importance of understanding the ethical justification for clinical interventions that are made in the neonatal intensive care unit.

KEYWORDS

Futility - resuscitation - Apgar score - infant - newborn - stillborn

REFERENCES

• 1 AAP .Textbook of Neonatal Resuscitation. 4th ed. Elk Grove Village, IL; American Academy of Pediatrics 2000: 7-20
• 2 Kattwinkel J, Niermeyer S, Nadkarni V et al.. Resuscitation of the newly born infant: an advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation.  Pediatrics. 1999;  103 e56
• 3 Lo B. Improving care near the end of life. Why is it so hard?.  JAMA. 1995;  274 1634-1636
• 4 Patel H, Beeby P J. Resuscitation beyond 10 minutes of term babies born without signs of life.  J Paediatr Child Health. 2004;  40 136-138
• 5 McCullough L B, Jones J W. Postoperative futility: a clinical algorithm for setting limits.  Br J Surg. 2001;  88 1153-1154
• 6 Jones J W, McCullough L B. Futility and surgical intervention.  J Vasc Surg. 2002;  35 1305
• 7 Tomlinson T, Brody H. Ethics and communication in do-not-resuscitate orders.  N Engl J Med. 1988;  318 43-46
• 8 Schneiderman L J, Jecker N S, Jonsen A R. Medical futility: its meaning and ethical implications.  Ann Intern Med. 1900;  122 954-959
• 9 Brody B A, Halevy A. Is futility a futile concept?.  J Med Philos. 1995;  20 123-144
• 10 Leplege A, Hunt S. The problem of quality of life in medicine.  JAMA. 1997;  278 47-50
• 11 Sarnat H B, Sarnat M S. Neonatal encephalopathy following fetal distress.  Arch Neurol. 1976;  33 696-705