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. It is possible that up to two thirds of these births can be avoided and this can be made possible by the method of care administered to such infants. The dilemma that emanates out of this is the ethical constraints surrounds the method chosen to prevent complications encountered by children born before term. There is a 5%-18% preterm birth range across 184 countries (Liu et al., 2016). It is apparent that the history of resuscitation is as ancient as medicine. Over time, standards of practices have been evolving and it has been 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. The first incident of resuscitation occurred in the 16 th century when Dr. William Tossach applied the procedure on a coal-pit miner who had suffocated. In 1874, for instance, Moritz Schiff a German physiologist revealed that massaging a person`s heart was bound to restore circulation (Baker, 1971). In the 19 th century, CPR methods were seen as primitive especially when used on preterm infants. In the mid-1950s, resuscitation began gaining prominence and approval from the society and that is when this technique started being used, however, since then controversy has always surrounded the issue of using the procedure on preterm infants since they appear frail to some people. Moreover, the technique has not been entirely successful, and there are many issues such as whether the physicians ought to consult the parent first before administering the procedure. This could be detrimental to the infant`s life since every second is crucial for their survival. A split second decision has to be made since this is what matters most both to the parent and physician. In the event that the child does not manage to survive, the parents may end up blaming the physician for not consulting them prior on the procedure they are supposed to use. The ethicality surrounding the resuscitation of preterm infants is thus bound to prevail.
Terminology
Preterm is a terminology which is used to refer to a child that has been born before 37 weeks. There is a categorization that was established to classify infants born preterm. The first pertains to extremely preterm whereby the baby is born less than 28 weeks. Secondly, very preterm is another category used when an infant is born within 28-32 weeks. Thirdly, in the instance, that the baby is conceived between 32-37 weeks, this is dubbed moderate to late preterm. In addition to this, there are certain ethical constraints that are bound to arise in regards to the issue of resuscitating children that are born prematurely. In order to regulate the basis within which such decisions are made by physicians, certain ethical considerations have been made in an attempt to ensure that the life of the preterm infant is sustained. Autonomy is one of the significant ethical doctrines that has to be considered. This purports that the individual has the right or freedom to make the choice which affects their lives (Nadroo, 2011). This is not fully sustainable since in the case of resuscitation of the preterm infant, the parent is tasked with this responsibility. Beneficence the second ethical principle requires that every action taken should benefit the infant. This almost relates to the third principle, nonmaleficence whereby no harm is to be caused on the preterm baby. Viability limits, nevertheless, withhold those administering care to the infant. This occurs since it is not easy for one to weigh options and determine the most viable one that is not capable of causing harm on the preterm baby. Some parents may fail to understand when a particular method is chosen to bring the baby out of danger leading the issue to become more complex. Justice is the last principle under the ethical doctrines outlined. In this case, it is necessary that every prematurely born infant is taken care of equally and fairly, in the same manner that one would like to be treated. But even with these guidelines in place, one would wonder what the physicians are required to do in case the parent of the prematurely born baby opts for a method that differs with medical practices.
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Both sides of the controversy (pro and con)
Pro
Delayed cord clumping is a common occurrence among preterm infants. This is a sign that administration of resuscitation is bound to reverse the condition and thus one of the main advantages. Moreover, 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, thus saving the baby`s life. Resuscitation further manages to increase the newborn`s heart rate for it to be within the acceptable limits.
Con
It is apparent that a preterm infant who has been resuscitated is at a great risk of experiencing a deterioration in their vital signs. In such a case, it is important for the baby to be moved to an environment where they can be monitored closely. It is also apparent that resuscitation is limited to the gestation period of the infant. For instance, there is a higher risk level when the procedure is performed on an infant below 25 weeks. Administration of resuscitation also requires that it occurs immediately. The procedure, therefore, leaves no time for the physician to consult the parent on whether to perform the risky method.
Conclusion
To sum it all up, one can discern that the advancement of neonatal care, has made it possible to successfully resuscitate infants born at gestation weeks 22 to 24, however, there are medical and ethical dilemmas associated with the decision to resuscitate due to the associated morbidity and mortality. Prior to the emergence of resuscitation, swinging, shaking, holding the baby upside down and squeezing their chest were some of the methods used. Later on, resuscitation emerged in the 18 th century and later on gained dominance. The greatest challenge lies on the ethicality of administering the procedure to preterm infants. Resuscitation is capable of saving a baby`s life when administered since it can manage to elevate their heart beat to the required level. The significant detriment of resuscitation among such infants is the duration of administration. When it is delayed, it is possible that the method will not manage to sustain the infant`s life. The parent of the child may also opt for an alternative means of engagement even when the physician knows this is the best procedure which has a higher chance of saving the baby. Until these ethical drawbacks are removed it is possible that the decision on whether to administer resuscitation might end up costing more preterm babies their lives.
Introduction
Dilemmas in resuscitation of preterm-born infants are inevitable and this poses complex ethical, social and medical challenges regardless of the efficiency with which the resuscitation is carried out. It is apparent that incidences of preterm births are seemingly uncommon with only 2% of such cases being experienced, and also with the advancement in modern technology, the rates of morbidity have significantly declined making it possible to save the lives of numerous infants. Viability which pertains to the sustenance of life out of the womb either by or without the incorporation of medical intervention is one significant disadvantages that lies with the administration of resuscitation, even with ethical challenges hampering the decision making process since it is almost impossible to offer optimal medical attention when making decisions. There are a variety of care techniques used by health care experts in saving preterm infants, however, resuscitation is the most ethically controversial method. While choosing the methods of care to utilize in saving the life of a such an infant, various examples of ethical principles in biomedical ethics have often been considered, for instance, autonomy, beneficence, non-maleficence and justice. Initially the survival rates which involved half of the pre-term infants was among those aged between 30-31 weeks, however, this has changed to 22 and 24 weeks of gestation. For example, in more developed countries like the United States, half of the preterm infants born within 22 and 24 weeks survive unlike in developing countries where the survival rate for half of the infants occurs among those aged 28 weeks or even more. It is apparent that the utilization of resuscitation is bound to save the life of 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. The advancement of neonatal care, has made it possible to successfully resuscitate infants born at gestation weeks 22 to 24, however, there are medical and ethical dilemmas associated with the decision to resuscitate due to the associated morbidity and mortality.
References
Baker, A. B. (1971). Artificial respiration, the history of an idea. Medical history , 15 (4), 336-351.
Liu, L., Oza, S., Hogan, D., Chu, Y., Perin, J., Zhu, J. ... & Black, R. E. (2016). Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. The Lancet , 388 (10063), 3027-3035.
Nadroo, A. M. (2011). Ethical dilemmas in decision making at limits of neonatal viability. The Journal of IMA , 43 (3), 188.
