Download PDF
Am J Perinatol 2006; 23(3): 159-162
DOI: 10.1055/s-2006-934095
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

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

Melanie P. McGraw1 , Jeffrey Perlman1 , Frank A. Chervenak1 , Laurence B. McCullough1
  • 1Division of Newborn Medicine, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, New York
Further Information

Publication History

Publication Date:
29 March 2006 (online)

    Permissions and Reprints

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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 3 Lo B. Improving care near the end of life. Why is it so hard?.  JAMA. 1995;  274 1634-1636
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 5 McCullough L B, Jones J W. Postoperative futility: a clinical algorithm for setting limits.  Br J Surg. 2001;  88 1153-1154
    CrossrefPubMedGoogle Scholar
  • 6 Jones J W, McCullough L B. Futility and surgical intervention.  J Vasc Surg. 2002;  35 1305
    CrossrefPubMedGoogle Scholar
  • 7 Tomlinson T, Brody H. Ethics and communication in do-not-resuscitate orders.  N Engl J Med. 1988;  318 43-46
    CrossrefPubMedGoogle Scholar
  • 8 Schneiderman L J, Jecker N S, Jonsen A R. Medical futility: its meaning and ethical implications.  Ann Intern Med. 1900;  122 954-959
    PubMedGoogle Scholar
  • 9 Brody B A, Halevy A. Is futility a futile concept?.  J Med Philos. 1995;  20 123-144
    CrossrefPubMedGoogle Scholar
  • 10 Leplege A, Hunt S. The problem of quality of life in medicine.  JAMA. 1997;  278 47-50
    CrossrefPubMedGoogle Scholar
  • 11 Sarnat H B, Sarnat M S. Neonatal encephalopathy following fetal distress.  Arch Neurol. 1976;  33 696-705
    CrossrefPubMedGoogle Scholar

Melanie P McGrawM.D. 

Division of Newborn Medicine, New York Presbyterian Hospital

Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10021

      >