Neonatal intensive care units may choose to selectively withdraw support in some neonates with severe brain damage. We offer suggestions for criteria for such withdrawal, and a review of 20 cases in which such a decision-making process occurred in our neonatal intensive care unit.
Get full access to this article
View all access options for this article.
References
1.
Duff, R.Guidelines for deciding care of critically ill or dying patients. Pediatrics1979:64:17-23.
2.
Jonsen AR, Phibbs RH, Tooley WH, et al. Critical issues in newborn intensive care: a conference report and policy proposal. Pediatrics1975;55:756-68.
3.
Ellison P., Walwork E.Follow-up of families of neonates in whom support was withdrawn. Submitted for publication, 1983.
4.
Ellison P., Evers J.Transcephalic impedance in the neonate: an indicator of intracranial hemorrhage, asphyxia, and delayed maturation. J Pediatr1981;98:968-71.
5.
Siddiqui S., Brown D., Dallman D., et al. Detection of neonatal-intraventricular hemorrhage using transcephalic impedance. Dev Med Child Neurol1980;22:440-7.
6.
Ellison P., Franklin S., Jones MGSerial EEG in the preterm infant as a predictor of neurological sequelae . Ann Neurol1982;12:213.
7.
Ellison P.Management of seizures in the high-risk infant. Clin Perinatol (in press).
8.
Sarnat H., Sarnat M.Neonatal encephalopathy following fetal distress. Arch Neurol1976;33:969-705.
9.
Papile L., et al. Posthemorrhagic hydrocephalus in low birth weight infants: treatment by serial lumbar punctures. J Pediatr1980 ;97:273-7.
10.
Black P.Brain death. New Engl J Med1978;299:338-44.
11.
Sweet W.Brain death. New Engl J Med1978;299:410-2.
12.
Stahlman M.Ethical dilemmas in perinatal medicine. J Pediatr1979;94:516-20.
13.
Monod, N., Dreyfus-Brisac C., Sfaello Z.Depistage et pronostic de l'etat de mal neonatal (d'apres l'etude electroclinique de 150 cas). Arch Franc Pediatr1969;26:1085-7.
14.
Monod N., Ducas P.The prognostic value of the electroencephalogram in the first two years of life. In: Kellaway P, Petersen I, eds. Clinical electroencephalography of children. New York: Grune and Stratton, 1969:61-76.
15.
Monod N., Pajot N., Guidasci S.The neonatal EEG: statistical studies and prognostic value in full-term and preterm babies. Electroencephalogr Clin Neurophysiol1972;32:529-44.
16.
Engle R.Abnormal electroencephalograms in the neonatal period. Springfield, II: Charles C Thomas, 1975:4-64.
17.
Tibbles J., Prichard J.The prognostic value of the electroencephalogram in neonatal convulsions . Pediatrics1965;35:778-86.
18.
Holmes G., Rowe J., Hafford J., et al. Prognostic value of the EEG in neonatal asphyxia. Electroencephalogr Clin Neurophysiol1982;53:60-72.
19.
Tharp B., Cukier N., Monod N.Valeur pronostique de l'EEG du premature. Rev Electroencephalogr Neurophysiol Clin1977;7:386-91.
20.
Sehring S., Schrumpf J., Hirata T.Prognostic significance of CT scan in the newborn. Pediatr Res1980;14:637.
21.
Fitzhardinge P.Computed tomography and ultrasound techniques for the diagnosis of intracranial hemorrhages in the newborn. In: Stern L, Oh W, ed. Neonatal intensive care— IV. New York : Masson, 1983 (in press).
22.
Schmidt E., Bender W., Breinl H.Creatinkinase und creatinkinase isoenzymatktivitaten bei neugeboren . Z Geburtshife Perinatol1979;183:51-7.
23.
Cao A.Serum creatinine kinase activity and serum creatine kinase isoenzymes in newborn infants. Biol Neonate1971;17:134-45.
24.
Becker M., Menzel I.Brain typical creatinine kinase in the serum of newborn infants with perinatal brain damage. Acta Pediatr Scand1978:67:177-80.
25.
Cuestas R.Creatinine kinase isoenzymes in high risk infants. Pediatr Res1980;14:935.
26.
Worly G., Lipman B., Gewolb I., et al. Creatinine kinase brain isoenzyme concentration CKBB in cerebrospinal fluid of newborns. Pediatr Res1981;15:687-89.
27.
Borkowski W. -89, Ellison P.Follow-up to one year of severely asphyxiated full-term infants and preterm infants with transcephalic impedance and creatine phosphokinase BB studies . Child Neurology Society Abstracts , October 1982.
28.
Hecox K., Cone B.Prognostic importance of brainstem auditory evoked responses after asphyxia . Neurology198 1;31:1429-34.