Newborns With Massive Intestinal Loss: Difficult Choices
Caniano, Donna A.
Kanoti, George A.
New England Journal of Medicine. 1988 Mar 17; 318(11): 703-707.
Caniano and Kanoti discuss the dilemmas of treating newborns with short bowel syndrome, a condition of "malabsorption and malnutrition resulting from a substantial loss of the small intestine and, occasionally, some or all of the large intestine." Infants with bowel loss too great to allow their residual intestine to adapt naturally to sustain enteral feeding face a life of total parenteral nutrition, which carries risks of infection, thrombosis, and catheter breakage. The authors discuss five therapeutic options in treating "Baby Y," an infant with severe bowel loss, that range from an experimental intestine transplant to intentional termination of life. They describe the ethical steps in choosing a treatment option and stress the importance of the health care team and the infant's parents participating in the decision. The final choice must be sensitive to the particulars of the case and adhere to the principles of freedom, benefit, and justice. (KIE abstract)
Active Euthanasia; Allowing to Die; Alternatives; Case Studies; Congenital Disorders; Critically Ill; Diagnosis; Disease; Ethical Analysis; Euthanasia; Enteral Feeding; Freedom; Health; Health Care; Iatrogenic Disease; Infants; Justice; Life; Minors; Moral Policy; Morbidity; Mortality; Newborns; Nutrition; Organ Transplantation; Parents; Patient Care; Physicians; Prognosis; Parenteral Feeding; Research; Risks and Benefits; Selection for Treatment; Surgery; Therapeutic Research; Transplantation; Twins;
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