Question

When a neonate has not progressed for multiple weeks in a row, do you feel providers should have the right to discontinue treatment without consent of the parents?

If it was agreed that there is a weight or gestation below what providers are technically able to treat, should they withhold resuscitation if an infant is born below it?

Answer 1

The concept of new born resuscitation occurs only when a baby born is not responding after birth which is commonly occurred at premature delivery .If the baby is born after a full gestation period and baby is crying and breathing then resuscitation is not at all required.

In my opinion discontinuation of treatment should only happen if the neonate does not respond to the resuscitation, no breath or heart rate even after multiple resuscitation then providers have the option to declare the neonate as dead. But if the neonate survive the initial resuscitation and respond to it than the neonate has to be given adequate care such as intubation and administration of Epinephrine and all other lifesaving drugs should be administered and should be properly monitored round the clock.

The decision to discontinue the treatment should be entirely given to the parents as they are the considered as the legal guardians of the neonate and the provider can always inform the expenses for the critical care of the neonate and the parents can decide if they can afford the cost of treatment for so many days. The prognosis of the new born has to clearly explained by the physician to the parents so that they will have a proper understanding on what is the possibilities for their neonate to come back to life and how many days and treatment cost is required for that.

To conclude even though provider can declare a new born dead if all the resuscitation activities fails and they have tried to resuscitate for more than 10 minutes, but if the neonate survives the initial phase and have a scope of survival then the decision to discontinue the treatment should be based on the decision of the parents.

2. Even if it is agreed, the scope of survival cannot be always judged with the parameters of gestation and the weight of the new born. I agree to the point that if the Apgar score is below 3 and is not showing any improvement in the entire phase of treatments for weeks then physicians can discuss with the parents regarding the severity of the condition and if they accept then the treatment can be discontinued. Even if the neonate born with zero possibilities should be given resuscitation and all measures should be taken to recover the neonate back to life. There cannot be a parameter which stops primary resuscitation to a new born which will be against the human rights (right to live)