Ethical considerations in the care of encephalopathic neonates treated with therapeutic hypothermia

Monica E Lemmon; Courtney J Wusthoff; Renee D Boss; Lisa Anne Rasmussen; Newborn Brain Society Guidelines and Publications Committee

doi:10.1016/j.siny.2021.101258

Ethical considerations in the care of encephalopathic neonates treated with therapeutic hypothermia

Semin Fetal Neonatal Med. 2021 Oct;26(5):101258. doi: 10.1016/j.siny.2021.101258. Epub 2021 Jun 12.

Authors

Monica E Lemmon¹, Courtney J Wusthoff², Renee D Boss³, Lisa Anne Rasmussen⁴; Newborn Brain Society Guidelines and Publications Committee

Affiliations

¹ Division of Pediatric Neurology and Developmental Medicine, Departments of Pediatrics and Population Health Sciences, Duke University School of Medicine, DUMC 3936, Durham, NC, 27710, USA. Electronic address: [email protected].
² Departments of Neurology and Pediatrics, Stanford University, Stanford, 750 Welch Road, Suite 317, Palo Alto, CA, 94304, USA. Electronic address: [email protected].
³ Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins Berman Institute of Bioethics, 200 N. Wolfe St, Suite 2019, Baltimore, MD, 21287, United States. Electronic address: [email protected].
⁴ Division of Palliative Care, Department of Family Medicine, Department of Neurology, Department of Pediatrics, Larner College of Medicine, University of Vermont, UVM Medical Center Palliative Care, 111 Colchester Avenue, Main Campus, Smith 262, Burlington, VT, 05401-1473, USA. Electronic address: [email protected].

Abstract

Engaging with ethical issues is central to the management of neonatal encephalopathy (NE). As treatment for these neonates evolves, new ethical issues will arise and many existing challenges will remain. We highlight three key ethical issues that arise in the care of neonates with NE treated with therapeutic hypothermia: facilitating shared decision making, understanding futility, and defining the boundaries between standard of care and research. Awareness of these issues will help clinicians counsel families in light of evolving treatments and outcomes.

Keywords: Decision making; Futility; Prognosis.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Brain Diseases* / therapy
Humans
Hypothermia, Induced*
Infant, Newborn

Grants and funding

K23 NS116453/NS/NINDS NIH HHS/United States