Critical care decisions in fetal and neonatal medicine: ethical issues

Major improvements in medical care mean that extremely premature and very ill babies have better chances of survival and making a good recovery. However, it can be difficult to predict whether an individual baby will have a limited lifespan and the extent to which he or she will recover from any health problems or develop disabilities. This means that families and health professionals sometimes have to make complex and emotionally demanding decisions about a baby’s treatment and care.

These decisions may be about:

• the care of a fetus and mother before the birth
• whether to resuscitate a newborn baby, and admit him or her to neonatal intensive care
• whether to continue invasive intensive care or replace active treatment with palliative care

Definitions

Fetal medicine

The branch of medicine that is concerned with the health and development of the unborn baby (or fetus).

Neonatal medicine

The branch of medicine that is concerned with the diagnosis and treatment of ill newborn babies.

Strictly speaking, the ‘newborn’ or ‘neonatal’ period is the time within 28 days of delivery.