Introduction
The management of infants whose births are extremely preterm remains a challenge despite the advancement in prenatal care. Difficulties in the resuscitation of preterm-born infants are inevitable as it poses complex ethical, social, and medical challenges. Medical advances have enabled preterm babies to survive with evidence of improved outcomes for resuscitation. The availability of an experienced team in preparation, delivery, and immediate care of a preterm infant have profoundly contributed to their stabilization and survival.
However, technological and medical advancement has barely improved the chances for survival of infants born extremely preterm. Survival without disabilities for such children is small as most suffer lifelong disabilities. Incidences of preterm births are seemingly uncommon, with only 2% of such cases being experienced. Also, with the advancement in modern technology, the rates of morbidity have significantly declined to make it possible to save the lives of numerous infants.
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Infants require a successful transition from the womb to the world, which requires significant physiological changes in the infant. There are a variety of care techniques used by health care experts in saving preterm infants preterm babies are unable to make the transition and therefore require additional support through resuscitation (Gaudine et al., 2011). Resuscitation is the most ethically controversial method due to the limitations of viability. While choosing the processes of care to utilize in saving the life of such an infant, various examples of ethical principles in biomedical ethics have often been considered. For instance, autonomy, beneficence, non-maleficence, and justice.
Viability, the most ethical controversy to resuscitation pertains to the sustenance of life out of the womb. Thus, sustainability is considered as a significant disadvantage that lies with the administration of resuscitation. Resuscitation is facilitated with or without the incorporation of medical intervention. Any decision about the resuscitation of infants is based on the limits of viability. Decision making becomes complex as it requires clear definitions of the limits of sustainability. The limitation of viability regarding supporters of resuscitation is defined as the acquiring of form and development of the infant attaining capability to survive outside the mother's womb (Gaudine et al., 2011).
On the other hand, the definition of viability has limited resuscitation where the definition suggests a minimum chance of long-term survival for an infant. The peri-viable (gestational age) for resuscitation to be undertaken has not been verified despite the issue been surrounded by constant ethical controversy (Aladangady & Rooy, 2012). The advancement of neonatal care has made it possible to resuscitate infants born at gestation weeks 22 to 24 successfully. However, there are medical and ethical dilemmas associated with the decision to revive due to the associated morbidity and mortality. The utilization of resuscitation is bound to save the life of an infant. Therefore, medical experts have recognized the need to acknowledge other factors relevant to resuscitation apart from viability.
Literature Review
Currently, preterm birth has been touted as the leading cause of neonatal mortality. According to the World Health Organization, up to 15 million babies are born preterm. In 2015, for instance, there were 1 million deaths, which resulted from such births. The dilemma that emanates out of this is the ethical constraints surrounds the method chosen to prevent complications encountered by children born before term. Neonatal intensive care unit (NICU) experience numerous ethical dilemmas despite advances in medicine are technology. Neonatologists have been equipped to provide premature infants with various services such as mechanical ventilation, intravenous nutrition, and artificial surfactant. However, the prevention of significant prematurity complications remains low with viability impacting neonatal care more profoundly.
History
In evaluating the history of resuscitation, it is clear that the standards of practices have evolved. The method has overgrown and is viewed as one of the best means of preventing the death of prematurely born infants. Before, resuscitation emerged in the ancient world, some common forms of therapies involved hitting the infant, swinging, shaking to some extent holding them upside down. Later on, this translated to squeezing the baby's chest gently (Baker, 1971). Afterwards, more rational means emerged, which involved administering Cardiopulmonary Resuscitation (CPR). It is imperative to note that the invention of medicine and advancement in technology did not immediately make it possible for the society to approve of resuscitation in infants.
Pros
The most solemn area addressed by neonatal ethics in decision making. Infants born prematurely are often at the limits of viability, which raises ethical, legal, social, and economic questions. Decision making for preterm infants is impacted by cultural, social, and legal factors. According to neonatologist's inability to predict outcomes of an infant born on the verge of viability affects the decision made in the provision of care to extremely premature infants (Aladangady & Rooy, 2012). Decision making involves parents and medical attendants and is affected by cultural differences such as varied perception on the quality and sanctity of life. There exist diverse options in acceptance of comfort care and the influences of medical practice.
Cons
The ethical issues and controversy in using the resuscitation procedure on preterm infants continue to be debated due to the delicate nature of infants born extremely premature. The success of the technique is also weighted down by issues of decision making in the determination of whether the physicians ought to consult the parent first before administering the procedure. Reaching the right choice is critical since delays can be detrimental to the infant's life, with every second being crucial for their survival (Gaudine et al., 2011). A split-second decision has to be made since this is what matters most both to the parent and physician. If the child does not manage to survive, the parents may end up blaming the physician for not consulting them before the procedure they are supposed to use. The ethicality surrounding the resuscitation of preterm infants is thus bound to prevail.
(Gaudine et al., 2011) Suggests that decision making is also influenced by discussions of medical professionals with parents about the initiation or withholding of resuscitation, which forms the fundamental controversy. Such arguments raise uncertainties about gestation, fetal weight, and risks of disability or death. As (Aladangady & Rooy, 2012) assesses, the agreement reached by clinicians on extreme gestation limits includes offering comfort care to infants born at 22 weeks of gestations. Between 23 and 25 weeks of pregnancy, the medical profession depicts indifference with practices differing among countries. Some countries have outlined other national recommendations which are not always followed or adhered and fail to meet the needs and preferences of parents.
Despite the controversy on decision making and the effect of cultural, social, economic, and ethical issues, resuscitation also is critical in safeguarding the lives of preterm babies. The technique is useful in activities such as improved breathing. Preterm babies, in some cases, end up experiencing low oxygen levels and thus leading to a lot of difficulty in breathing. In such a case, resuscitation is bound to improve circulation once administered. Resuscitation increases a newborn's heart rate to acceptable limits and can reverse the condition of delayed cord clamping, which is a common occurrence among preterm infants. (Nadroo, 2011).
On the other hand, the preterm infant who has been resuscitated is at a high risk of experiencing a deterioration in their vital signs. In such a case, the baby needs to be moved to an environment where they can be monitored closely (Aladangady & Rooy, 2012). Most preterm babies suffer from severe and lifelong disabilities. In most cases, extremely preterm infants cannot survive without resuscitation. Thus, to receive help, tubes must be inserted in their airway and immediate steps taken to start their heart. Resuscitation is not always a sure process; despite the efforts, babies still fail to survive. Discussion with parents or family may lead to disagreements on resuscitation with family arguing against the technique has found it as an additional option for their baby.
Conclusion
All governments provide laws which protect the rights of children and infants. For example, under the United Nations Declaration of the Rights of the Child (1959), a child "shall be entitled to grow and develop in health; to this end, special care and protection shall be provided both to him and his mother, including adequate prenatal and post-natal care." Such laws lead to challenges in making decisions of the child. It is therefore critical, as argued by (Aladangady & Rooy, 2012) to arrive at decisions jointly. Parents and the health care team consider the interests of the infant depending on their current condition.
Significant advancement on neonatal care has been achieved, which has made it possible to resuscitate infants born at gestation weeks 22 to 24 successfully. However, there exist medical and ethical dilemmas associated with the decision to revive due to the associated morbidity and mortality. The application of the procedure in preterm infants forms the most significant moral challenge. Resuscitation is capable of safeguarding a preterm infant life when administered by elevating its heartbeat to the required level. The procedure also poses a substantial detriment in decision making since the duration of administration is a crucial consideration. When delayed, the technique may fail to sustain the infant's life.
References
Aladangady, N., & Rooy, L. (2012). Withholding or withdrawal of life sustaining treatment for newborn infants. Early Human Development, 88 , 65-69
G audine, A., Lamb, M., LeFort, S.M. & Thorne, L. (2011). Barriers and facilitators to consulting hospital clinical ethics committees. Nursing Ethics, 18 (6), 767-780.
Nadroo, A. M. (2011). Ethical dilemmas in decision making at limits of neonatal viability. The Journal of IMA, 43(3), 188.
