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Withholding and Withdrawing Life-Sustaining Treatment

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Emerging Topics and Controversies in Neonatology

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Abstract

Although neonatologists are not newcomers to issues related to life and death, how infants die in the intensive care unit has changed. Previously infants died in spite of life sustaining interventions. Now, infants generally die after intensive care is withdrawn or withheld, either because infants are physiologically unstable or for reasons of quality of life.

Some infants are also discharged home with complex care needs and survive for a period of time. Thus, dialogue in the medical community is shifting from the mechanics of interventions or treatment withdrawal to conversations about quality of life, nuances of decision making and supportive care for both the infant and parents.

Emphasis on how to integrate palliative care principles early in disease trajectories have become an integral part of the neonatologist’s role. In this chapter, we take the approach that this journey begins early in the neonatal course and focus on how to optimise the integration and delivery of intensive, as well as palliative care.

We will explore potential barriers impeding conversations about transitioning goals, contemplate what defines ‘good’ palliative care, discuss communication and decision-making strategies and illustrate how parental input can help define quality of ‘palliative’ and ‘end of life’ care and help establish best practice standards.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Albert Einstein College of Medicine, Children’s Hospital at Montefiore, Bronx, NY, USA

    Marlyse F. Haward

  2. Université de Montréal, Montréal, QC, Canada

    Annie Janvier

  3. CHU Sainte-Justine, Montréal, QC, Canada

    Annie Janvier

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  1. Marlyse F. Haward
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  2. Annie Janvier
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Correspondence to Marlyse F. Haward .

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Editors and Affiliations

  1. Department of Health Sciences, George Davies Centre for Medicine, University of Leicester, Leicester, UK

    Elaine M. Boyle

  2. Department of Health Sciences, George Davies Centre for Medicine, University of Leicester, Leicester, UK

    Jonathan Cusack

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Haward, M.F., Janvier, A. (2020). Withholding and Withdrawing Life-Sustaining Treatment. In: Boyle, E., Cusack, J. (eds) Emerging Topics and Controversies in Neonatology. Springer, Cham. https://doi.org/10.1007/978-3-030-28829-7_30

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  • DOI: https://doi.org/10.1007/978-3-030-28829-7_30

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