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Extra info for Avery's Diseases of the Newborn, 8th Edition
Second, for an ELBW infant of uncertain viability, born at 23 to 24 weeks of gestation, reasonable persons may disagree whether the burden of treatment is proportionate to the benefits that can reasonably be expected. The informed judgment of the parent or parents should prevail in this instance over the personal choice of the clinician, resuscitation being withheld if the treatment is judged to be disproportionately burdensome. Third, failure to resuscitate an ELBW infant born at 25 weeks of gestation or later may be considered medical neglect, in light of such an infant’s more favorable chance of an acceptable long-term outcome, and may perhaps justify resuscitation regardless of parental wishes (depending on the presence or absence of other prognostic factors).
At the same time, public attention shifted to the alleged overtreatment of ELBW premature infants who may have a poor prognosis for meaningful survival. Improvements in fetal imaging and surgical techniques have also made possible fetal surgical interventions both at mid-gestation and just before delivery. Although previously the debate had focused on “selective non-intervention” for infants born with spina bifida, controversy has shifted to the selection criteria for operating on unborn fetuses with spina bifida in hopes of improving neurologic and functional outcomes (Sutton et al, 1999).
Nih. gov/cochrane/ Duncan R: Computers in neonatology. html/ Fuller S: Creating the future: IAIMS planning premises at the University of Washington. Bull Med Libr Assoc 80:288-293, 1992. Fuller S: Regional health information systems: Applying the IAIMS model. J Am Med Inform Assoc 4:S47-S51, 1997. Fuller SS, Ketchell DS, Tarczy-Hornoch P, Masuda D: Integrating knowledge resources at the point of care: Opportunities for librarians. Bull Med Libr Assoc 87:393-403, 1999. GeneTests Web site. org/ Guyatt GH, Rennie D (eds): Users’ Guide to the Medical Literature: A Manual for Evidence-Based Clinical Practice.