Critically ill infants in neonatal intensive care units withholding treatment. Medical search. Frequent questions

Combination therapy (ampicillin and either gentamicin or cefotaxime) is typically used in the initial treatment of newborns and young infants. (medscape.com)
1] For more than 40 years, neonatal medicine has been practiced to provide specialized and intensive care measures aimed at improving the health and survival of premature and critically ill newborns. (medscape.com)
These questions aim to address the ethical concerns raised by caring for critically ill newborns. (medscape.com)

Recent progress in neonatal care have significantly improved the prognosis and chances of survival of critically ill or extremely preterm neonates and have modified the limits of viability. (omeka.net)
Starting on feeding day 2, extremely preterm infants 28 weeks or younger fed maternal or donor milk were randomized to receive either a diet fortified with a human-based product (intervention group) or a standard, unfortified diet (control group). (aap.org)
In infants born extremely preterm, human milk diets fortified soon after birth do not increase FFM accretion at 36 weeks' PMA, but they may increase length gain velocity and reduce declines in head circumference-for-age z scores from birth to 36 weeks' PMA. (aap.org)
Partial enteral nutrition with unfortified human milk during the first 2 postnatal weeks can be insufficient to prevent cumulative nutritional deficits in infants born extremely preterm (28 weeks of gestation or less). (aap.org)

METHODS: International, multi-center prospective observational study of mechanically ventilated children, 1 month to 18 years of age, receiving EN. (bvsalud.org)
CONCLUSION: Intermittent versus continuous EN strategy is not associated with differences in energy or protein adequacy, or acquired infections, in mechanically ventilated, critically ill children. (bvsalud.org)
Sections on the prevention of bacterial pneumonia in mechanically ventilated and/or critically ill patients, care of respiratory-therapy devices, prevention of cross-contamination, and prevention of viral lower respiratory tract infections (e.g., respiratory syncytial virus {RSV} and influenza infections) have been expanded and updated. (cdc.gov)

Enteral nutrition with unfortified human milk during the first 2 postnatal weeks often leads to cumulative protein and energy deficits among preterm infants. (aap.org)
Breastfeeding is a challenge for very preterm and/or sick infants, due to the difficulties related to the underlying pathology and to the specific nutritional requirements. (biomedcentral.com)

OBJECTIVE: To determine whether screening continuous EEG monitoring (cEEG) is associated with greater odds of treatment success for neonatal seizures.METHODS: We included term neonates with acute symptomatic seizures enrolled in the Neonatal Seizure Registry (NSR), a prospective, multicenter cohort of neonates with seizures. (stanford.edu)
Multivariable logistic regression analyses assessed the association between cEEG approach and successful seizure treatment.RESULTS: Among 514 neonates included, 161 (31%) had screening cEEG and 353 (69%) had confirmatory cEEG. (stanford.edu)

We aimed to compare nutrition and infection outcomes in critically ill children receiving intermittent or continuous EN. (bvsalud.org)
What outcomes of neonatal intensive care are too burdensome? (medscape.com)
Continuous Electroencephalogram Use and Hospital Outcomes in Critically Ill Children. (stanford.edu)

Rather, a patient-centered model prioritizes relief of suffering and tailors care to increase the quality of life for terminally ill patients. (wikipedia.org)
For example, the American Society of Clinical Oncology recommends that patients with advanced cancer should be "referred to interdisciplinary palliative care teams that provide inpatient and outpatient care early in the course of disease, alongside active treatment of their cancer" within eight weeks of diagnosis. (wikipedia.org)
PATIENTS: Infants with Bochdalek CDH were admitted to the ICU between January 2009 and December 2019 and survived until hospital discharge. (bvsalud.org)
Sensitivity analyses were performed after excluding patients who crossed over between intermittent and continuous EN. (bvsalud.org)
Patients receiving continuous EN (N = 1093) had a higher prevalence of respiratory illness and obesity, and lower prevalence of neurologic illness and underweight status on admission, compared to those on intermittent EN (N = 282). (bvsalud.org)
Discharge status, length of hospitalization, and health care cost were compared between patients with and without CEEG use. (stanford.edu)
After 4 years, critically ill children with hypoglycemia scored significantly worse for certain parent/caregiver-reported executive functions (working memory, planning and organization, metacognition) than patients without hypoglycemia, also when adjusted for risk factors including baseline NSE and S100B. (biomedcentral.com)
High-risk elderly patients receiving nonsurgical treatment for aortic stenosis (AS) are rarely studied. (aacnjournals.org)
They should feel comfortable with this knowledge in order to provide care, educate patients and others, and fulfill their professional obligations without undue fear or anxiety. (netce.com)

The rate of handicap or significant morbidity appears to have remained steady or declined in survivors of the neonatal intensive care unit (NICU) of nearly all gestational ages and weights. (medscape.com)
These questions are often raised at the bedside while providing care, during teaching rounds, and during special ethics rounds held in the NICU. (medscape.com)

Likewise, a longer duration of stay in the pediatric intensive care unit (PICU), also indicating higher illness severity, prolongs the exposure to glucose control strategies and hence increases the odds of developing a hypoglycemic event. (biomedcentral.com)

A substantial reduction in the mortality of premature infants has occurred. (medscape.com)
Furthermore, the rate of birth defects remains relatively constant, and infant mortality, although diminished over the past decade, remains higher in the United States than in many other developed nations. (medscape.com)
Finally, the persistent discrepancy between black and white infant mortality remains a concern. (medscape.com)

The distinction between palliative care and hospice differs depending on global context. (wikipedia.org)
We investigated whether hypoglycemia in PICU differentially associates with outcome in the context of withholding early PN, and whether any potential association with outcome may depend on the applied glucose control protocol. (biomedcentral.com)

Streptococcus pneumoniae is the most common bacterial pathogen in infants aged 1-3 months. (medscape.com)

The primary outcome was successful response to initial seizure treatment, defined as seizures resolved without recurrence within 30 minutes after initial loading dose of anti-seizure medicine. (stanford.edu)
To study whether an association of hypoglycemia with outcome may be affected by the nutritional strategy or center-specific glucose control protocol, we further adjusted the models for the interaction between hypoglycemia and the randomized nutritional strategy, respectively, treatment center. (biomedcentral.com)
These novel tests and treatment options have generally not been assessed in presymptomatic individuals and knowledge on long-term outcome of treatment is lacking. (cdc.gov)

In such circumstances the limitation of intensive treatments (withholding or withdrawing) and shift towards palliative care, can represent a more humane and reasonable alternative. (omeka.net)
Palliative care (derived from the Latin root palliare, or 'to cloak') is an interdisciplinary medical caregiving approach aimed at optimizing quality of life and mitigating suffering among people with serious, complex, and often terminal illnesses. (wikipedia.org)
Within the published literature, many definitions of palliative care exist. (wikipedia.org)
In the past, palliative care was a disease specific approach, but today the WHO takes a broader patient-centered approach that suggests that the principles of palliative care should be applied as early as possible to any chronic and ultimately fatal illness. (wikipedia.org)
Palliative care is appropriate for individuals with serious illnesses across the age spectrum and can be provided as the main goal of care or in tandem with curative treatment. (wikipedia.org)
Palliative care can be provided in a variety of contexts, including hospitals, outpatient, skilled-nursing, and home settings. (wikipedia.org)
Although an important part of end-of-life care, palliative care is not limited to individuals near the end of life. (wikipedia.org)
Evidence supports the efficacy of a palliative care approach in improvement of a person's quality of life. (wikipedia.org)
It is commonly the case that palliative care is provided at the end of life, but it can be helpful for a person of any stage of illness that is critical or any age. (wikipedia.org)
Palliative care is able to improve healthcare quality in three sectors: Physical and emotional relief, strengthening of patient-physician communication and decision-making, and coordinated continuity of care across various healthcare settings, including hospital, home, and hospice. (wikipedia.org)
The overall goal of palliative care is to improve quality of life of individuals with serious illness, any life-threatening condition which either reduces an individual's daily function or quality of life or increases caregiver burden, through pain and symptom management, identification and support of caregiver needs, and care coordination. (wikipedia.org)
Palliative care can be delivered at any stage of illness alongside other treatments with curative or life-prolonging intent and is not restricted to people receiving end-of-life care. (wikipedia.org)
Historically, palliative care services were focused on individuals with incurable cancer, but this framework is now applied to other diseases, including severe heart failure, chronic obstructive pulmonary disease, multiple sclerosis and other neurodegenerative conditions. (wikipedia.org)
Forty million people each year are expected to need palliative care, with approximately 78% of this population living in low and middle income countries. (wikipedia.org)
Palliative care can be initiated in a variety of care settings, including emergency rooms, hospitals, hospice facilities, or at home. (wikipedia.org)
For some severe disease processes, medical specialty professional organizations recommend initiating palliative care at the time of diagnosis or when disease-directed options would not improve a patient's prognosis. (wikipedia.org)
Appropriately engaging palliative care providers as a part of patient care improves overall symptom control, quality of life, and family satisfaction of care while reducing overall healthcare costs. (wikipedia.org)
Hospice care services and palliative care programs share similar goals of mitigating unpleasant symptoms, controlling pain, optimizing comfort, and addressing psychological distress. (wikipedia.org)

As neonatal medicine has developed in the United States, clinical ethics (ie, bioethics, medical ethics, healthcare ethics) have also become increasingly present in the healthcare environment. (medscape.com)

Percent energy or protein adequacy (energy or protein delivered/prescribed × 100) and acquired infection rates were compared between intermittent and continuous EN groups using adjusted-multivariable and 4:1 propensity-score matched (PSM) analyses. (bvsalud.org)
Behavioral health professionals will continue to play a major and significant role in preventing the spread of HIV infection and in caring for those who are infected or affected by HIV. (netce.com)

Pneumonia accounts for 13% of all infectious illnesses in infants younger than 2 years of age. (medscape.com)

However, in some circumstances, when the child's death can only be briefly postponed at the price of severe suffering, or when survival is associated with severe disabilities and an intolerable life for the child and his/her parents, the application of the full armamentarium of modern neonatal intensive care may not be appropriate. (omeka.net)

There have been many advances in clinical care for cystic fibrosis during the past 50 years, such as the widespread implementation of newborn screening for early diagnosis, enhanced mucociliary clearance techniques, and improvements in nutrition (including adjusted pancreatic enzyme replacement therapy and a high-energy, high-fat diet). (cdc.gov)

The availability of special-care nursery beds has increased dramatically, as has the number of professionals and specialists trained to care for this vulnerable population. (medscape.com)
Beyond that, failing to answer these questions perpetuates an inability or unwillingness to responsibly address the value-laden charge that comes with professing to be willing and able to help a newborn who is vulnerable and sick, which is the charge to practice the art of medicine with scientific rigor, technologic skill, and human caring, even in the face of medical uncertainty. (medscape.com)

Terms that describe the age of onset (juvenile or adult) or type of treatment ( insulin - or non- insulin -dependent) are no longer used because of overlap in age groups and treatments between disease types. (msdmanuals.com)

Are some babies too sick or too premature for newborn intensive care? (medscape.com)

Cough is the most common symptom of pneumonia in infants, along with tachypnea, retractions, and hypoxemia. (medscape.com)

This shift was important because if a disease-oriented approach is followed, the needs and preferences of the patient are not fully met and aspects of care, such as pain, quality of life, and social support, as well as spiritual and emotional needs, fail to be addressed. (wikipedia.org)

This document updates and replaces CDC's previously published 'Guideline for Prevention of Nosocomial Pneumonia' (Infect Control 1982;3:327-33, Respir Care 1983;28:221-32, and Am J Infect Control 1983;11:230-44). (cdc.gov)
To be effective and provide compassionate care, adequate and up-to-date information about transmission, prevention, and care of HIV-infected individuals must be obtained by all behavioral health professionals. (netce.com)

Further adjustment for the interaction of hypoglycemia with the randomized intervention or treatment center revealed a potential interaction, whereby tight glucose control and withholding early PN may be protective. (biomedcentral.com)

Current data show that point-of-care ultrasonography helps accurately diagnose most cases of pneumonia in children and young adults. (medscape.com)
Initial priorities in children with pneumonia include the identification and treatment of respiratory distress, hypoxemia, and hypercarbia. (medscape.com)
Previously, hypoglycemia occurring under tight glucose control in critically ill children receiving early PN did not associate with long-term harm. (biomedcentral.com)
Critically ill children exposed to hypoglycemia in PICU were at higher risk of impaired executive functions after 4 years, especially in cases of spontaneous/recurrent hypoglycemia. (biomedcentral.com)

Ethical Issues In Neonatal Intensive Care Units. (omeka.net)
This article examines and discusses the ethical principles underlying such difficult decisions, the most frequent situations in which these decisions may be considered, the role of parents in the decisional process, and the opinions and behaviours of neonatologists of several European neonatal intensive units as reported by the EURONIC study. (omeka.net)
This article considers 3 questions that pertain to some of the ethical issues raised in neonatal medicine. (medscape.com)

Intensive control of plasma glucose can prevent or delay many of these complications but may not reverse them once established. (msdmanuals.com)

These questions remain at the root of what many healthcare professionals see as continuing dilemmas in providing neonatal intensive care. (medscape.com)

Noxious experiences may be unavoidable in critical care, but whether sedation ameliorates their adverse effects is unknown. (aacnjournals.org)

MEASUREMENTS AND MAIN RESULTS: One hundred forty-two infants (58% male, mean birth weight 3.08 kg, 80% left-sided defects) met inclusion criteria. (bvsalud.org)

Care 1983;28:221-32, and Am J Infect Control 1983;11:230-44). (cdc.gov)

This course is designed for all behavioral health professionals, including social workers, counselors, and marriage and family therapists, who may be involved with the care of persons with HIV or AIDS. (netce.com)

BACKGROUND & AIMS: Intermittent enteral nutrition (EN) may have physiologic benefits over continuous feeding in critical illness. (bvsalud.org)

Eleven infants died during the observation period. (aap.org)
When it does occur, it typically takes place after a period of intensive and often prolonged treatment. (omeka.net)

Are the costs of neonatal intensive care acceptable? (medscape.com)

Fortified human milk administered soon after birth could increase fat-free mass (FFM) and improve growth in these infants. (aap.org)

Can electronic medical records predict neonatal seizures? (stanford.edu)
This means many medical staff visit and advise on aspects of the patient care, often at separate times to other teams involved. (chestervetclinic.com)

This study's purpose was to measure Health-Related Quality of Life (HRQL) and test reliability of the Minnesota Living with Heart Failure questionnaire (MLHFQ), Geriatric Depression Scale (GDS), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale (FACIT-Sp) in persons more than 70 years old receiving nonsurgical treatment for AS. (aacnjournals.org)

o Admitting team should be involved in any major changes to patient care and should be informed of significant changes in patient condition. (chestervetclinic.com)

The past 10 years of cystic fibrosis treatment: the road to cure. (cdc.gov)

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