ABSTRACT
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Subject(s)
Male , Infant, Newborn , Humans , Sepsis/complications , Sepsis/diagnosis , Sepsis/mortality , Herpes Simplex/complications , Herpes Simplex/diagnosis , Herpes Simplex/mortality , Hepatic Insufficiency/complications , Hepatic Insufficiency/diagnosis , Hemorrhage/complications , Infant Mortality/trends , Necrosis , Hemochromatosis/complications , Infections/complicationsABSTRACT
OBJECTIVE: To know the cause of death and the criteria used in the vital support limitation decisions in the critical newborn who eventually died. PATIENTS AND METHODS: A retrospective review of the medical records for all newborns who died in the NICU between 1987-1994 was performed. The following actions were defined: total vital support, do not resuscitate order (DNR), vital support withdrawal (VSW). RESULTS: The mortality rate in the NICU was 7.3% (55/753), with a neonatal mortality rate of 2.98 per thousand live births. Medical records of 53 patients were reviewed. In 67.9% of the patients (36/53; p < 0.001) the therapeutical effort was limited. The most frequent way of action was the VSW (35.8%) and the support most frequently interrupted was mechanical ventilation (89%). DNR was established in 32%. Only 42% of the parents were involved in the decision making process to limit support. In three patients (6%), there was evidence of disagreement between the medical team and the family and the parents of two opting for a more aggressive care. In the three cases, the family determined the course of action. In general, the decision of support limitation was justified based on "bad prognosis". Retrospectively, the criteria were: not viable (11%), eminent death (14%), no response to treatment (22%) and quality of life judgments (53%). CONCLUSIONS: It is very frequent to take decisions on vital support limitation in neonates when they are in a critical situation. We consider that the individual evaluation of each patient's prognosis, combined with standards of ethical criteria, the "child's best interest" and the "potential for relation", pondered in a rational way, constitute an adequate guideline for making conflictive ethical decisions together with the child's parents.
Subject(s)
Decision Making , Ethics, Medical , Infant, Newborn , Life Support Care , Birth Weight , Gestational Age , Humans , Infant, Premature , Retrospective StudiesABSTRACT
A prospective evaluation of the immunogenicity, protective efficacy and safety of the recombinant hepatitis B vaccine associated to the immunoglobulin (IG) in newborns with high risk of infection by the hepatitis B virus was carried out. Two groups of newborns were used. The first group was formed by children with HBsAG carrier mothers (56 children) and the second group consisted of newborns of mothers negative for HBsAG, but having a high risk of infection (21 children). Within the first few hours of life, all of the newborns received a dose (20 mcg) or recombinant vaccine and 0.5 ml of IG. New doses of vaccine were administered at one and six months of life. At eight months of age, the anti-HBs seroconversion rate in children belonging to groups 1 and 2 was 100%, with an elevated anti-HBs titer and with no detected cases of positive HBsAG. On a long term basis (39 +/- 5 months), only 5.6% of the children present an anti-HBs titer < 10 mUI/ml. The recombinant hepatitis B vaccine associated to IG is immunogenic and provides efficient protection in newborns. Important side effects were not observed.
