Points of ethical issues in resuscitation

2. NEONATAL RESUSCITATION:
POST RESUSCITATION CARE
AND ETHICAL ISSUES
PRESENTED BY:
MR. AMAR MULLA,
M. Sc. (N), Ph. D. SCHOLAR
SVBCON, SILVASSA, DNH

3. What normally happens at birth to allow a
baby to get oxygen from the lungs?
• The fluid in the alveoli is absorbed into lung
tissues and replaced by air.
• The umbilical arteries and vein constrict and
then are clamped.
• As a result of the gaseous distension and
increased oxygen in the alveoli, the blood
vessels in the lung tissue relax, decreasing
resistance to blood flow.

4. What can go wrong during transition?
• The baby may not breathe sufficiently to force
fluid from the alveoli or foreign material such as
meconium.
• Excessive blood loss may occur, or there may be
poor cardiac contractility or bradycardia from
hypoxia and ischemia
• A failure of gaseous distension of the lungs of lack
of oxygen may result in sustained constriction of
the pulmonary arterioles.

5. CLINICAL FINDINGS OF THE
COMPROMISED BABY:
• Poor muscle tone
• Depression of respiratory drive
• Bradycardia
• Low blood pressure
• Tachypnea
• Cyanosis

6. CARE OF THE NEONATE AFTER
RESUSCITATION:
1. Routine Care:
• Thermoregulation
• Observation of breathing
• Observation of activity
• Observation of colour

7. 2. Observational Care:
• Meconium staining of the amniotic fluid or
skin
• Baby should be cared under radiant
warmer
• Admitting baby in NICU
• Cardio Pulmonary Monitoring

8. 3. POST RESUSCITATION CARE:
• Baby’s who require positive pressure ventilation or
more extensive resuscitation may require ongoing
support
• Temperature control
• Close monitoring of vital signs
• Continue to monitor oxygen saturation, heart rate and
blood pressure.
• Laboratory studies
• Blood gas analysis

9. • Post resuscitation complications:
1. Pulmonary hypertension
2. Pneumonia and other lung complications
3. Metabolic Acidosis
4. Hypotension
5. Renal dysfunction
6. Seizures or apnea
7. Hypoglycemia
8. Feeding problems
9. Hypothermia or hyperthermia

10. Post – resuscitation Care to prevent
Systemic Complications:
Organ
System
Potential
Complication
Post resuscitation Action
Brain Apnea
Seizure
Monitor for apnea
Support ventilation as
needed
Monitor glucose and
electrolytes
Avoid hyperthermia
Consider anticonvulsant
therapy

11. Organ
System
Potential
Complication
Post
resuscitation
Action
Lungs Pulmonary hypertension
Pneumonia
Pneumothorax
Transient tachypnea
Meconium Aspiration
Syndrome
Surfactant Deficiency
Oxygenation and
Ventilation
Consider
antibiotics
Obtain X – ray
Surfactant therapy
Delay feeding

12. Cardio
Vascular
Hypotension Monitor blood pressure
and heart rate
Consider Inotrops and
volume replacement
Kidney Acute tubular
necrosis
Monitor urine output
Restrict fluids if baby is
oliguric and vascular
volume is adequate
Monitor Sr. Electrolytes

13. Gastro
Intestinal
Ileus
Necrotising
Enterocolitis
Delay initiation of
feeding
Give IV fluid as per
need
Consider
parenteral
nutrition

14. Metabolic /
hematologic
Hypoglycemia
Hycalcemia
Hyponitremia
Anemia
Thrombocyto-
penia
Monitor blood
Sugar
Monitor Sr.
Electrolytes
Monitor
hematocrit
Monitor platelets

15. ETHICAL ISSUES
• PRINCIPLES TO BE FOLLOWED:
1. Benevolence
2. Justice
3. . Benevolent Injustice
4. Autonomy
5. Nonmaleficence

16. 1. BENEVOLENCE
• Beauchamp and Childress
define benevolence as
"the character trait or virtue of
being disposed to act for the benefit
of others

17. 2. JUSTICE
• Justice, as defined by John Rawls, is an
equal share or equal opportunity to all.
• For neonates, this means that all newborns
are given access to the NICU

18. 3. BENEVOLENT INJUSTICE
• A benevolent injustice occurs when the well-
intentioned treatment efforts of a physician
or a medical team produce an outcome that
limits the potential of a patient or renders
them technologically dependent.

19. 4. AUTONOMY
• Respecting an individuals rights of
freedom and liberty to make
changes that affect his or her life

20. 5. NONMALEFICENCE
• Avoiding harming people
unnecessarily

21. POINTS TO KEEP IN MIND
1. The chance that the treatment will succeed
2. The risks involved with treatment and
nontreatment
3. The degree to which the therapy, if successful, will
extend life
4. The pain and discomfort associated with therapy
5. The anticipated quality of life for the newborn with
and without treatment

22. PARENTS ROLE IN DECISION MAKING
• Primary role in determining the goals
of care delivered to newborn
• Informed Consent: Complete and
reliable information

23. SITUATIONS IN WHICH IT IS ETHICAL
NOT TO INITIATE RESUSCITATION
1. Newborns with a confirmed gestational age of
less than 23 weeks or birth weight less than
400 g.
2. Anencephaly
3. Confirmed trisomy 13 or trisomy 18
syndrome
4. Uncertain prognosis

24. Any Questions?

25. Thank you