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4. Who should decide for critically ill neonates and how? (Book chapter)

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ISBN: 9781760020590 Year: Pages: 19 Language: English
Publisher: The Federation Press Grant: Wellcome Trust
Subject: Medicine (General)
Added to DOAB on : 2019-01-15 13:34:12
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Abstract

This chapter distinguishes between essential features of the zone of parental discretion and the longstanding concept of a grey zone in neonatal treatment decision-making. The grey zone has traditionally described a gestational age range where the outcomes of medical treatment for newborn infants are uncertain, and therefore parents have discretion to choose between resuscitation or palliative care options. In contrast, the ZPD refers to a space where parents may make decisions for their child (not restricted to newborns) even if their decisions conflict with the decisions a clinician would make. A key difference between the two zones is that the boundaries of the grey zone are defined on the basis of published evidence about medical outcomes, whereas the boundaries of the ZPD are based on the broader but arguably vaguer notion of harm to the particular child. The grey zone has usually been defined in terms of gestational age. Wilkinson argues instead for a prognosis-based grey zone in neonatal treatment decision-making, which incorporates a range of prognostic factors rather than focusing solely on gestational age.

Keywords

Neonates --- ill --- decisions

Neonatal Screening for Critical Congenital Heart Defects

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ISBN: 9783039210480 / 9783039210497 Year: Pages: 98 DOI: 10.3390/books978-3-03921-049-7 Language: eng
Publisher: MDPI - Multidisciplinary Digital Publishing Institute
Subject: Social Sciences --- Sociology
Added to DOAB on : 2019-06-26 08:44:06
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Critical congenital heart defects (CCHDs) are potentially life-threatening malformations that remain a significant cause of neonatal mortality and morbidity. Failure to diagnose these conditions shortly after birth may result in acute cardiovascular collapse and death. The identification of CCHDs by routine newborn clinical examination is routine in many countries, but consistently misses over a third of cases, and, although antenatal ultrasound screening can be very effective in early diagnosis, the provision and accuracy of ultrasound screening is highly variable. As most CCHDs present with mild cyanosis (hypoxaemia), which is frequently clinically undetectable, pulse oximetry is a rapid, simple, painless method of accurately identifying hypoxaemia, which has gained popularity as a screen for CCHD. This Special Issue of the International Journal of Neonatal Screening, devoted to ""Neonatal Screening for Critical Congenital Heart Defects (CCHDs)"", will consider the evidence for CCHD screening with pulse oximetry, the acceptability and cost-effectiveness of this intervention, the additional non-cardiac conditions which it may also identify, and international experiences of introducing CCHD screening across the globe.

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