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Birth asphyxia is the most common single cause of death in term newborn infants. The majority of deaths in developed countries follow decisions to withdraw intensive care. Recent technological advances, particularly the use of magnetic resonance imaging (MRI) of the brain, may affect the process of prognostication and decision-making. There is little existing evidence about how prognosis is determined in newborn infants and how this relates to treatment withdrawal decisions. An exploratory qualitative study was performed using in-depth semi-structured interviews with a sample of ten neonatologists from tertiary intensive care units in the UK. Participants were purposively selected to ensure a range of experience and type of unit. They were asked about the process of prognostication for infants with birth asphyxia and decisions about treatment withdrawal. Interviews were transcribed and thematically analysed. MRI played a significant role in decision-making about life-sustaining treatment for a number of clinicians. Clinicians did not identify particular ethical concerns related to MRI, though wider discussion revealed issues relating to uncertainty around predictions, the timing of prognostication and decision-making, and difficulty in predicting quality of life.

Type

Journal article

Journal

Monash Bioeth Rev

Publication Date

03/2010

Volume

29

Pages

05.1 - 0519

Keywords

Adult, Asphyxia Neonatorum, England, Female, Humans, Infant, Newborn, Magnetic Resonance Imaging, Male, Middle Aged, Practice Patterns, Physicians', Prognosis, Quality of Life, Uncertainty, Withholding Treatment