Treatment of Critically III Newborns

Abstract

No more devastating event can befall parents than the birth of an abnormal or seriously ill child. A very prematurely born infant must be included in this category; in fact, 10% of newborns weighing 2,000 to 2,500 g will die despite the most heroic treatment. Moreover, the spectrum of congenital illness is vast and includes birth defects resulting from a complex interaction of genetic and environmental factors. The American Academy of Pediatrics agrees with the Department of Health and Human Services of the federal government that the decision to treat or not treat seriously ill newborns should not be based on concomitant handicapping conditions, such as Down's syndrome or other congenital anomalies. However, we strongly oppose the remedy proposed by the DHHS. The President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research also strongly opposes the federal government's proposal. The pediatric research societies, the American Hospital Association, the National Association for Children's Hospitals and Related Institutions, and many other organizations and individuals including, we believe, the vast majority of the AAP membership, are opposed to these regulations. A better remedy, we believe, is the establishment in each hospital of an internal review procedure whenever the decision to forgo life-sustaming therapy is being considered. The Academy's official policy with regard to the treatment or nontreatment of critically ill newborns has been developed by our Committee on Bioethics in consultation with the Committees on Fetus and Newborn, Hospital Care, and Children with Handicaps. It is published below. Pediatrics, although the official journal of the American Academy of Pediatrics, publishes many commentaries that do not represent official AAP policy.