NRP Lesson 9

You are called to counsel the parents of a fetus who is believed to be at the lower limits of viability and whose birth is imminent. What should you tell the parents when they ask you how decisions about resuscitation are made?

Which statement describes the ethical principle(s) that guide the resuscitation of a newborn?

In the course of planning care for a newborn with a known genetic disorder, one of your team members suggests that no resuscitation be offered. The parents agree. Other team members think this decision might jeopardize them personally. Which of the following statements is true?

When a fetus has a borderline chance of survival, and there is a high rate of complications, what should be included in your discussion with the parents concerning options for resuscitation?

You are part of a team called to an emergency cesarean delivery done for apparent acute placental abruption at 41 weeks' gestation. The newborn emerged without respirations or heart rate and has had no detectable heart rate (by palpation or by oximetry monitoring) from the time the baby was first assessed. You and the team are convinced that resuscitation has been adequate (good chest movement with positive-pressure ventilation; timely and correct placement of umbilical catheter and administration of medications; fluids; and performance of chest compressions). After what duration of time might it be appropriate to discontinue resuscitative efforts?

In most cases, who is (are) the usual and appropriate surrogate decision maker(s) for a newborn?

A woman is admitted at 24 weeks' gestation with rupture of membranes, maternal fever, and premature labor. The baby is likely to be born within the next few hours with an estimated weight of 750 g. The care team offers the parents counseling. What is likely to be helpful in this process?

You are called to the birth of a newborn weighing 385 g and gestational age of just under 23 weeks, a birth weight that is associated with almost certain early death and nearly universal rate of severe morbidity among the rare survivors. Which action is appropriate?

You are counseling a set of 17-year-old parents, whose baby is about to be born at 23 weeks' gestation. You have explained that survival is unlikely and that in the event of survival, the likelihood of severe long-term morbidity is high. The parents firmly request that everything be done, starting with resuscitation at birth. How might you answer them?

Good decisions are based on good data. Which statement about obstetric dating and assessment is correct?