Skip to main content

The Lure of Technology: Considerations in Newborns with Technology-Dependence

  • Chapter
  • First Online:
Ethical Dilemmas for Critically Ill Babies

Part of the book series: International Library of Ethics, Law, and the New Medicine ((LIME,volume 65))

Abstract

For a minority of children managed in the NICU, there is a need for more complex technologic assistance in order to sustain life, mitigate a more chronic debilitation from a pervasive life-limiting condition, or provide a bridge from life-sustaining therapy to a more semi-permanent treatment such as organ transplantation. This chapter will address two major types of technology assistance for infants and children—tracheostomy and assisted home ventilation, and dialysis—and the myriad complications and considerations that they raise. Some attention to why clinicians may be so inclined to impose technology as a solution to life-limiting conditions will be noted, as well as why some parents may seem to insist on pursuing technology.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 129.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hofmannin B. Is there a technological imperative in health care? Internat J Technol Assess Health Care. 2002;18(32):675–89.

    Google Scholar 

  2. American College of Obstetricians and Gynecologists Committee on Ethics and American Academy of Pediatrics Committee on Bioethics. Maternal-fetal intervention and fetal care centers. Committee Opinion No. 501. Obstet Gynecol. 2011;118:405–10.

    Google Scholar 

  3. Feudtner C, Villareale NL, Morray B, Sharp V, Hays RM, Neff JM. Technology-dependency among patients discharged from a children’s hospital: a retrospective cohort study. BMC Pediatrics. 2005;5(1):8.

    Article  Google Scholar 

  4. Amin R, et al. Pediatric long-term home mechanical ventilation: twenty years of follow-up from one Canadian center. Pediatr Pulmonol. 2014;49:816–24.

    Article  Google Scholar 

  5. Benneyworth BD, et al. Inpatient health care utilization for children dependent on long-term mechanical ventilation. Pediatrics. 2011;127:e1533–41.

    Article  Google Scholar 

  6. Al-Samri M, et al. Tracheostomy in children: a population-based experience over 17 years. Pediatric Pulmonol. 2010;45:487–93.

    Google Scholar 

  7. Edwards JD, et al. Outcomes and causes of death in children on home mechanical ventilation via tracheostomy: an institutional and literature review. J Pediatr. 2010;157:955–9.

    Article  Google Scholar 

  8. Graf JM, et al. Children with new tracheostomies: Planning for family education and common impediments to discharge. Pediatr Pulmonol. 2008;43:788–94.

    Google Scholar 

  9. Rafferty A, et al. Retrospective, cross-sectional review of delayed discharge after paediatric tracheostomy. J Laryngol Otol. 2012;126:1247–53.

    Google Scholar 

  10. Hopkins C, et al. The impact on paediatric tracheostomy on both patient and parent. Int J Pediatr Otorhinolaryngol. 2009;73:15–20.

    Google Scholar 

  11. Joseph RA, et al. Parental quality of life: caring for an infant or toddler with a tracheostomy at home. Neonatal Netw. 2014;33(2):86–94.

    Article  Google Scholar 

  12. Needle JS, et al. Influence of personal preferences for life-sustaining treatment on medical decision making among pediatric intensivists. Crit Care Med. 2012;40:2464–9.

    Article  Google Scholar 

  13. Wilfond BS. Tracheostomies and assisted ventilation in children with profound disabilities: navigating family and professional values. Pediatrics. 2014;133(1):S44–9.

    Article  Google Scholar 

  14. Bresolin N, Silva C, Halllal A, et al. Prognosis for children with acute kidney injury in the intensive care unit. Pediatr Nephrol. 2009;24:537–44.

    Article  Google Scholar 

  15. DurkanAM Alexander T. Acute kidney injury post neonatal asphyxia. J Pediatr. 2011;158:e29–33.

    Article  Google Scholar 

  16. Chang JW, Tsai HL, Wang HH, Yang LY. Outcome and risk factors for mortality in children with acute renal failure. Clin Nephrol. 2008;70:485–9.

    Google Scholar 

  17. Bienstock JL, Birsner ML, Coleman F, Hueppchen NA. Successful in utero intervention for bilateral renal agenesis. Obstet Gynecol. 2014;124 (2 Pt 2 Suppl. 1):413–5.

    Google Scholar 

  18. Hijazi R, Abitbol CL, Chandar J, Seeherunvong W, Freundlich M, Zilleruelo G. Twenty-five years of infant dialysis: a single center experience. J Pediatr. 2009;155:111–7.

    Article  Google Scholar 

  19. Kari JA, Gonzalez C, Ledermann SE, Shaw V, Rees L. Outcome and growth of infants with severe chronic renal failure. Kidney Internat. 2000;57:1681–7.

    Article  Google Scholar 

  20. Klaassen I, Neuhaus TJ, Mueller-Wiefel DE, Kemper MJ. Antenatal oligohydramnios of renal origin: long-term outcome. Nephrol Dial Transplant. 2007;22:432–9.

    Article  Google Scholar 

  21. Tong A, Lowe A, Sainsbury P, Craig JC. Parental perspectives on caring for a child with chronic kidney disease: an in-depth interview study. Child: Care Health Dev. 36, 4:549–557.

    Google Scholar 

  22. Laakkonen H, Taskinen S, Rönnholm K, Holmberg C, Sandberg S. Parent–child and spousal relationships in families with a young child with end-stage renal disease. Pediatr Nephrol. 2014;29:289–95.

    Article  Google Scholar 

  23. Abrahão SS, Ricas J, Andrade DF, et al. Difficulties experienced by children/adolescents with chronic kidney disease and by their families. J Bras Nefrol. 2010;32:16–20.

    Google Scholar 

  24. Park KS, Hwang YJ, Cho MH, et al. Quality of life in children with end-stage renal disease based on a PedsQL ESRD module. Pediatr Nephrol. 2012;27:2293–300.

    Google Scholar 

  25. Lantos JD, Warady BA. The evolving ethics of infant dialysis. Pediatr Nephrol. 2013;28:1943–47.

    Google Scholar 

  26. Carter BS. How can we say to neonatal intensive care unit parents amid crisis, “You are not alone”? Pediatrics. 2002;110:1245.

    Article  Google Scholar 

  27. October TW, Fisher KR, Feudtner C, Hinds PS. The parent perspective: “being a good parent” when making critical decisions in the PICU. PediatrCrit Care Med. 2014;15:291–8.

    Article  Google Scholar 

  28. Meyer EC, Lamiani G, Foer MR, Truog RD. “What would you do if this were your child?” Practitioners’ responses during enacted conversations in the United States. PediatrCrit Care Med. 2012;13:e372.

    Article  Google Scholar 

  29. Korones DN. What would you do if it were your kid? N Engl J Med. 2013;369:1291–3.

    Article  Google Scholar 

  30. Halpern J. What is clinical empathy? J Gen Intern Med. 2003;18:670–4.

    Article  Google Scholar 

  31. Feudtner C, Morrison W. The darkening veil of “do everything. JAMA Pediatr. 2012;166:694–5.

    Google Scholar 

  32. Hoffmann PB, Schneiderman LJ. Physicians should not always pursue a good “clinical” outcome. Hastings Cent Rep. 2007;inside back cover.

    Google Scholar 

  33. Hirni K, Carter B. Hearing others’ perspectives when we hear, “do everything!”. JAMA Pediatr. 2015;169(5):423–4.  

    Google Scholar 

  34. Shields l, Kristensson-Hallstrom I, O’Callaghan M. An examination of the needs of parents of hospitalized children: comparing parents’ and staff’s perceptions. Scand J Caring Sci. 2003;17:176–184.

    Google Scholar 

  35. Kopelman A. Understanding, avoiding, and resolving end-of-life conflicts in the NICU. Mount Sinai J Med. 2006;73:580–6.

    Google Scholar 

  36. Postman N. Technopoly: The surrender of culture to technology. New York: Vintage Books;1993. p. 13.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Brian Carter .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer Science+Business Media Dordrecht

About this chapter

Cite this chapter

Carter, B., Miller-Smith, L. (2016). The Lure of Technology: Considerations in Newborns with Technology-Dependence. In: Verhagen, E., Janvier, A. (eds) Ethical Dilemmas for Critically Ill Babies. International Library of Ethics, Law, and the New Medicine, vol 65. Springer, Dordrecht. https://doi.org/10.1007/978-94-017-7360-7_10

Download citation

Publish with us

Policies and ethics