NEONATAL INTENSIVE CARE GOALS
Category: Child Health
Abstract : GOALS OF NEONATAL INTENSIVE CARE - Overview Healthcare professionals may
experience frustration at the lack of specific resource material that provides a
ready answer to these questions. If such material were available and agreed
upon, the vexing nature of these questions may have long since passed. Although
a difference of opinion in material authored by philosophers, clergy, lawyers,
GOALS OF NEONATAL INTENSIVE CARE - Overview
Healthcare professionals may
experience frustration at the lack of specific resource material that provides a
ready answer to these questions. If such material were available and agreed
upon, the vexing nature of these questions may have long since passed.
Although
a difference of opinion in material authored by philosophers, clergy, lawyers,
administrators, healthcare professionals, and parents is expected, one may think
that some hint about the goals of neonatal intensive care could be found. This
is not necessarily true.
After reviewing major textbooks and the medical
literature, as well as attending local, regional, and national meetings for
years, this writer scarcely has found or heard the goals of neonatal intensive
care publicly stated. This is the basis of the problem encountered when working
through ethically challenging situations. Involved professionals and parents
first must come together and decide what neonatology is about. Neither the
simply stated goal "to save all babies" nor "to reduce infant mortality" says
enough.
In addressing ethical issues in the NICU, at all times consider
the goals of specific monitoring, diagnostic tests, therapies, or research
protocols that are administered. Center the goals of care on the patient and the
family. The patient is treated, but the family must live with the long-term
consequences of the daily decisions made in caring for the
baby.
Essential Components
Skilled professional care
Goals include
more than the simple application of critical care technology, such as
ventilators, monitors, medications, invasive devices, and a multiplicity of
laboratory measurements, to sick and premature newborn patients.
The
goals of neonatal intensive care include the provision of skilled professional
care. This requires trained professionals of many disciplines to create an
effective team of providers who render neonatal intensive care; no single
professional can do this alone.
Physical constraints
Care is extended
over a necessarily limited period of time. The simple physical constraints of a
nursery environment make evident the unsuitable nature of the NICU for older
infants and children. The developmental needs of growing newborns and young
infants are difficult to meet in the NICU environment from the standpoint of
staffing, time utilization, and patient access and interaction (with family or
staff) throughout the passing months.
Conclusion of care
The ends to
which care is provided include initial stabilization of the newborn and,
ultimately, facilitation of the transition to normal, extrauterine, neonatal
physiology. This transition takes longer for some infants and may require
significant intervention and support. The reversal of acute disease processes,
such as infection and respiratory distress, is a recognized
end.
Iatrogenic effects
Minimizing chronic or debilitating outcomes,
including iatrogenic sequelae of applied neonatal intensive care, falls within
these goals. The potential for negative iatrogenic effects in much of what is
performed in neonatal practice must be recognized. Such effects may result from
the following:
• Environment in which the baby is managed
• Mode of
ventilation
• Types, doses, and results of medications used
•
Short-term and long-term effects of certain procedures
• Foreign bodies
or devices used
• How the baby's nutritional needs are met Expected
outcomes Provide care with a reasonable expectation of steady improvement. Care
should proceed with the absence of unnecessary pain and avoidable suffering.
Develop care toward a capacity for the newborn to enjoy and participate in the
human experience over a life prolonged beyond infancy.
Parents
Goals
seek to maintain a focus upon the best interests of the child. In determining
the best interests of the child, the parents generally are considered to be the
spokespersons; hence, seek their opinions, discern their values, and consider
their goals.
Decision-making Methods
Shared decision making should be
the commonly employed process, requiring shared information among relevant care
providers and a willingness and capability to communicate effectively with
parents. This process also suggests the need for outcome data. Such data should
be relevant to the population seeking care at a given institution. Relying on
national or other reported regional or institutional data from outside a
particular practice setting is not always valid, because data from different
practice settings likely are neither constituted nor controlled in the same
fashion.
The provision of care, which is decided on by local clinical and
population data, and the determination of best interests, or what can be viewed
as either effective, beneficial, and appropriate care versus ineffective,
burdensome or inappropriate care, demand the availability of data from which to
make these determinations with parents. Until such data are available,
healthcare professionals should be frank in recognizing and communicating some
uncertainty in their decisional process with parents.
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