Avery's Diseases of the Newborn, 8th Edition by H. William Taeusch, Roberta A. Ballard, Christine A. Gleason

By H. William Taeusch, Roberta A. Ballard, Christine A. Gleason

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The continued use of unproven or innovative therapies that have not been validated through properly designed clinical trials does little to advance our knowledge of those interventions that truly benefit critically ill neonates (Tyson, 1995). Recognizing the difficulty of obtaining informed and voluntary consent from the parents in situations of stress, we should nevertheless provide unproven treatments within the context of a clinical trial (Mason and Allmark, 2000; Tyson and Knudsen, 2000). Clinical trials usually involve a number of interventions, with the risks and benefits requiring individual consideration.

Judgments about the disproportionate burden of treatment involve the relative value and risk (or probability) of different outcomes and should not be imposed unilaterally. Treatments that are strictly futile can be withdrawn or withheld unilaterally, but this label applies to an extremely limited set of interventions. For example, continued endotracheal intubation and mechanical ventilation are not strictly futile even for an anencephalic infant, because such support corrects the physiologic abnormality of respiratory insufficiency.

The membranes and fetal surface should be shiny and translucent. An odor may FIGURE 4–7. Circumvallate placenta. Note the insertion of the membranes into the placenta halfway between the edge of the placenta and the center. IUGR IUGR, intrauterine growth retardation; TRAP, twin reversed arterial perfusion; TTT, twin-to-twin transfusion. suggest infection, and cultures of the placenta may be beneficial (Benirschke and Kaufmann, 2000). Greenish discoloration may represent meconium staining or old blood; placentas with such discoloration should be sent to the pathologist for complete histologic examination.

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