CHORIOAMNIONITIS FOUND NOT TO BE RELATED TO PREMATURITY
Polam S, Koons A, Anwar M, Shen-Schwarz S, Hegyi T. Effect of chorioamnionitis on neurodevelopmental outcome in preterm infants. Arch Pediatr Adolesc Med. 2005;159:1032-1035.
The reasons that prematurity occur and the subsequent health of the infant continue to be major healthcare concerns. This study investigated whether chorioamnionitis in the mother before delivering a very low-birth-weight infant was linked with neurodevelopmental deficits when the infant was older.
A sample of 177 infants born at 22 to 29 weeks gestation between 1997 and 2000 were studied. Of these, 102 had mothers who had been treated for chorioamnionitis, whereas 75 were controls without a history of chorioamnionitis. All of the infants were assessed at 3, 6, 12, 18, 24, 36, and 48 months of age. At each of these times, the infants were tested using the Bayley Scales of Infant Development II for their mental and motor development and received a neurological examination as well. The practitioners who administered these tests were blinded from the infants' group assignments.
Data analysis showed that when the demographic characteristics of the infants were compared, there were no differences found between the groups regarding their birth weights, gestations ages, Apgar scores, use of maternal antibiotics, or use of maternal steroids. When these characteristics were controlled for, there was no difference found in the infants' neurodevelopmental status at any age related neither to these characteristics nor of their history of maternal chorioamnionitis. The history of the infection did not relate at all to their progress as they grew older.
Therefore, the researchers in this study proposed that maternal chorioamnionitis was not related to prematurity or to any developmental difficulties in these survivors of very low birth weight.
TEXAS ADVANCE DIRECTIVES ACT HELPS FAMILIES TO MAKE HEALTHCARE DECISIONS
Fine RL, Whitfield JM, Carr BL, Mayo TW. Medical futility in the neonatal intensive care unit: hope for a resolution. Pediatrics. 2005;116:1219-1222.
The tragedy of families deciding whether to withdraw futile medical treatment from their hopelessly terminally ill children is a sad one. Many parents and healthcare providers struggle with the decision to withdraw medical treatment when it is apparent that the care cannot preserve life.
This case study reported on the application of a law in Texas that helps to provide a balanced decision-making process in ethical dilemmas such as those when continued medical treatment is futile. In this situation, an 825-g premature infant continued to have significant health problems after suffering respiratory distress syndrome, pulmonary interstitial emphysema, bilateral grade 3 intraventricular hemorrhages, severe progressive posthemorrhagic hydrocephalus, bacterial sepsis, patent ductus arteriosus, hyperbilirubinemia, inoperable necrotizing enterocolitis, and a systemic fungal infection.
The neonatologists told the mother (age 14 years) and grandparents that further treatment was futile and that withdrawal of life-sustaining ventilator therapy was recommended. The family refused; thus, the Texas Advance Directives Act was used. The law provided that the parents received written information on the situation, were invited to attend the ethics committee discussion on the infant's case, and were given a written report of the ethics committee recommendations. The law provided that if the parents declined to follow the ethics committee recommendations, they had 10 days to find another healthcare facility that was willing to take the infant for treatment. At this point, the family tried to find another facility; however, they could not find one. They then declined to get a court order to grant an extension of time to seek out another facility and allowed the ventilator to be removed from the infant. The infant died peacefully in the presence of his family.
The Texas Advance Directives Act was useful in this heart-wrenching situation and allowed the family to have considered information and decision-making power regarding their infant's health condition that was not compatible with life. Although a sad series of events, the family was able to make their own decisions about their child's life while, at the same time, receiving the proper information on their choices.