NRP Lesson 9 Ethics and Care at the End-of-Life Questions and Correct Answers.

Which statement best describes the ethical principles that guide the resuscitation of a newborn? - Answer The approach to decisions in the newborn should be guided by the same principles used for adults and older children You are called to counsel the parents of a fetus who is believed to be at the lower limits of viability whose birth is imminent. What should you tell the parents when they ask you how decisions about resuscitation are made? - Answer The decision agreed before birth may need to be modified based on the condition of the baby after birth and the postnatal gestational age assessment. A woman is admitted at 24 weeks gestation with rupture of membranes, maternal fever, and premature labor. The baby is likely to be born in the next few hours with an estimated weight of 750 g. The care team offers the parents counseling. What is likely to be helpful in the process? - Answer It is worth obtaining up-to-date outcome data for your institution or region, or use the NRP website and National Institute of Child Health and Human Development estimator for national data. When a fetus has a borderline chance of survival, and there is a high rate of complications, what should be included in your discussion with the parents concerning options for resuscitation? - Answer The option of only providing comfort care can be considered. You are part of a team called to an emergency cesarean delivery done for apparent acute placental abruption at 41 weeks gestation. The newborn emerged without respirations or heart rate and has had no detectable heart rate (by palpation or by oximetry monitoring) from the time the baby was first assessed. You and the team are convinced that resuscitation has been adequate (good chest movement with PPV, timely and correct placement of umbilical catheter and administration of medications, fluids, and performance of chest compressions.) After what duration might it be appropriate to discontinue resuscitative efforts? - Answer After 10 minutes of asystole You are called to the birth of a newborn weighing 385g and gestional age of just under 23 weeks, a birth weight that is associated with almost certain early death and nearly universal rate of severe morbidity among rare survivors. Which action is appropriate? - Answer Attempts at resuscitation are not indicated under these circumstances, care should focus on comfort alone. In the course of planning care for a newborn with a known genetic disorder, one of your team members suggests that no resuscitation be offered. The parents agree. Other team members think this decision might jeopardize them personally. Which of the following statements is true?