Naissances très prématurées : dilemmes et propositions de prise en charge. Seconde partie : enjeux éthiques, principes de prise en charge et recommandations [Very premature births: Dilemmas and management. Second part: Ethical aspects and recommendations].

Details

Serval ID
serval:BIB_A692A8A836D5
Type
Article: article from journal or magazin.
Publication sub-type
Review (review): journal as complete as possible of one specific subject, written based on exhaustive analyses from published work.
Collection
Publications
Title
Naissances très prématurées : dilemmes et propositions de prise en charge. Seconde partie : enjeux éthiques, principes de prise en charge et recommandations [Very premature births: Dilemmas and management. Second part: Ethical aspects and recommendations].
Journal
Archives de Pédiatrie
Author(s)
Moriette G., Rameix S., Azria E., Fournié A., Andrini P., Caeymaex L., Dageville C., Gold F., Kuhn P., Storme L., Siméoni U.
Working group(s)
Groupe de réflexion sur les aspects éthiques de la périnatologie
Contributor(s)
Altavilla AG., Andrini P., Aujard Y., Azria E., Bétrémieux P., Boitias C., Chabernaud JL., Collet M., Dageville C., Danan C., Debillon T., De Dreuzy P., Dehan M., Denizot S., Deruelle P., Dommergues M., Farnoux C., Fournié A., Gold F., Gouyon JB., Grassin M., Guidicelli B., Huillery ML., Jarreau PH., Jouannic JM., Kracher S., Kuhn P., Le Coz P., Lequien P., Mahieu-Caputo D., Moriette G., Narcy P., Oriot D., Parat S., Puech F., Rameix S., Ropert JC., Rozé JC., Simeoni U., Storme L., Vernier D.
ISSN
1769-664X (Electronic)
ISSN-L
0929-693X
Publication state
Published
Issued date
2010
Peer-reviewed
Oui
Volume
17
Number
5
Pages
527-539
Language
french
Notes
Publication types: English Abstract ; Journal Article Publication Status: ppublish
Abstract
In the first part of this work, the outcome following very premature birth was assessed. This enabled a gray zone to be defined, with inherent major prognostic uncertainty. In France today, the gray zone corresponds to deliveries occurring at 24 and 25 weeks of postmenstrual age. The management of births occurring below and above the gray zone was described. Withholding intensive care at birth for babies born below or within the gray zone does not mean withholding care but rather providing palliative care to prevent pain and suffering during the time period preceding death. Given the high level of uncertainty, making good decisions within the gray zone is problematic. Decisions should be based on the infant's best interests. Decisions should be reached with the parents, who are entitled to receive clear and comprehensive information. Possible decisions to withhold intensive care should be made following the procedures described in the French law of April 2005. Guidelines, based on gestational age and the other prognostic elements, are proposed to the parents before birth. They are applied in an individualized fashion, in order to take into account the individual features of each case. At 25 weeks, resuscitation and/or full intensive care are usually proposed, unless unfavorable factors, such as severe growth restriction, are associated. A senior neonatologist will attend the delivery and will make decisions based on both the baby's condition at birth and the parents' wishes. At 24 weeks, in the absence of unfavorable associated factors, the parents' wishes should be followed in deciding between initiating full intensive care or palliative care. Below 24 weeks, palliative care is the only option to be offered in France at the present time.
Keywords
Decision Making, Ethics Committees/legislation & jurisprudence, Ethics, Medical, Fetal Viability, hic" UI="D005602">France, Gestational Age, Guideline Adherence/ethics, Guideline Adherence/legislation & jurisprudence, Humans, Infant, Extremely Low Birth Weight, Infant, Newborn, Infant, Premature, Diseases/mortality, Infant, Premature, Diseases/therapy, Intensive Care, Neonatal/ethics, Palliative Care/ethics, Palliative Care/legislation & jurisprudence, Professional-Family Relations/ethics, Prognosis, Resuscitation/ethics, Resuscitation Orders/ethics, Resuscitation Orders/legislation & jurisprudence, Withholding Treatment/ethics, Withholding Treatment/legislation & jurisprudence
Pubmed
Web of science
Create date
22/02/2015 11:39
Last modification date
20/08/2019 16:11
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