NEONATAL INTENSIVE-CARE AND THE PREMATURE-INFANT - CRITERIA FOR INTERVENTION

Most very premature infants cannot survive without aggressive support provided in a neonatal intensive care unit (NICU). The outcome for most of these infants is excellent, but a small proportion do suffer varying degrees of disability. Ethical dilemmas derive principally from our limited ability to Predict outcome. The decision whether to intervene with aggressive support and how long to maintain is made it by looking at the impact of those decisions on the infant, the family and society. This is the basis of utilitarian ethics - to do the most good or the least harm. The aggressive intervention available in an NICU can produce serious morbidity and is very expensive. The author concludes that, over the long term, the best solution lies in preventing or controlling prematurity rather than in struggling with its sequelae-