Neonatology pp 219-228 | Cite as

The Process of Decision-Making in Neonatology

  • Endla K. AndayEmail author
  • Michael Spear
Reference work entry


Advances in the field of neonatal–perinatal medicine over the past 40 years have resulted in marked improvement in survival and outcome of the prematurely born and critically ill infant. While the overall reduction in mortality and morbidity for infants is favorable, decisions regarding the care provided to newborns at the threshold of viability and those with complex medical, surgical, and potentially lethal congenital anomalies continue to present challenges to the families and healthcare providers. The dilemma surrounding the complexity of the decision-making process is based on a number of factors including the rights of the child as an individual, the values of the family and the healthcare personnel, the cultural influences, and the moral and ethical standards that impact the way physicians practice medicine and their approach to end-of-life decision-making. As an adjunct to help facilitate the process of decision-making, the role of neonatal palliative care has increased over the last few years. In fact, the field of pediatric palliative care and neonatal palliative care is relatively new and will provide added benefit to healthcare providers and families as they are confronted with difficult decisions.


  1. Am Acad of Ped Neonatal Resuscitation Prog Steering Comm (2003) Born-alive infant protection act of 2001 public law no 107-207. Pediatric 111:680Google Scholar
  2. American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG) (2012) Guidelines for perinatal care, 7th edn. Elk Grove Village (IL)Google Scholar
  3. American Academy of Pediatrics, Committee on Bioethics (1994) Guidelines on forgoing life-sustaining medical treatment. Pediatrica 93(3):532–536Google Scholar
  4. Baby Doe Law (1984) USCA Title 42 Chapter 67 Sec 510a (
  5. Bechara A, Damasio H, Damasio AR (2000) Emotion, decision making and the orbitofrontal cortex. Cereb Cortex 10(3):295–307CrossRefGoogle Scholar
  6. Bell EF (2007) Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrica 119(2):401–403CrossRefGoogle Scholar
  7. Born-Alive Infants Protection Act (2001) 107th congress 1st session HR 2175. 1–38
  8. Boss RD, Hutton N, Sulpar LJ, West AM et al (2008) Values parents apply to decision-making regarding delivery room resuscitation for high-risk newborn. Pediatrica 122(3):583–589CrossRefGoogle Scholar
  9. Carter B (2015) End of life decision for newborns: an ethical and compassionate process? Arch Dis Child Fetal Neonatal Ed 101(2):F92–93. doi10.1136/archdischild - 2015.309380CrossRefGoogle Scholar
  10. Casebeer WD (2003a) Moral cognition and its neural constituents. Nat Rev Neurosci 4:840–846CrossRefGoogle Scholar
  11. Casebeer WD (2003b) Natural ethical facts: evolution, connectionism, and moral cognition. MIT Press, Cambridge, MAGoogle Scholar
  12. Curlin FA, Lawrence RE, Chin MH, Lantos JD (2007) Religion, conscience, and controversial clinical practices. N Engl J Med 356(6):593–600CrossRefGoogle Scholar
  13. Damasio A (2007) Neuroscience and ethics: intersections. AJOB 7(1):3–10PubMedGoogle Scholar
  14. Garten L (2015) Primary palliative care in the delivery room: patients’ and medical personnel’s perspectives. J Perinatol 35:1000–1005. IA L (2013) Conflict resolution in end-of-life decisions in the neonatal unit. Semin Fetal Neonatal Med 83–87CrossRefGoogle Scholar
  15. Gazzaniga RB, Ivry RB, Mangun GR (2002) Cognitive neuroscience: the biology of the mind, 2nd edn. Norton & Company, New YorkGoogle Scholar
  16. Greene JD, Sommerville RB, Nystrom LE, Darley JM et al (2001) An fMRI investigation of emotional engagement in moral judgment. Science 293:2105–2108CrossRefGoogle Scholar
  17. Haward MF, Murphy RO, Lorenz JM (2008) Message framing and perinatal decisions. Pediatrica 122:109–118CrossRefGoogle Scholar
  18. Hippocrates (1977) The art. In: Reiser SJ, Dyck AJ, Curran WJ (eds) Ethics in medicine: historical perspectives and contemporary concerns. MIT Press, Cambridge, MA, pp 6–7Google Scholar
  19. International Liaison Committee on Resuscitation (2006) The International Liaison Committee on Resuscitation (ILCOR) consensus on science with treatment recommendations for pediatric and neonatal patients: neonatal resuscitation. Pediatrica 117(5):978CrossRefGoogle Scholar
  20. Ishii N, Kono Y, Yonemoto N et al (2013) Outcomes of infants born at 22 and 23 weeks’ gestation. Pediatrica 132(1):62–71CrossRefGoogle Scholar
  21. Janvier A, Leblanc MD, Barrington KJ (2008) The best-interest standard is not applied for neonatal resuscitation decisions. Pediatrica 121(5):963–969CrossRefGoogle Scholar
  22. Leuthner S (2001) Decisions regarding resuscitation of the extremely premature infant and models of best interest. J Perinatol 21(3):193–198CrossRefGoogle Scholar
  23. Lorenz JM (2005) Prenatal counseling and resuscitation decisions at extremely premature gestation. J Pediatr 147(5):567–568CrossRefGoogle Scholar
  24. Mancini A (2013) Training neonatal staff for the future in neonatal palliative care. Semin Fetal Neonatal Med 18:111–115CrossRefGoogle Scholar
  25. Miller EK, Cohen JD (2001) An integrative theory of prefrontal cortex function. Annu Rev Neurosci 24:167–202CrossRefGoogle Scholar
  26. Paris JJ (2005) Resuscitation decisions for “fetal infants”. Pediatrica 115(5):1415CrossRefGoogle Scholar
  27. Paris JJ, Graham N, Schreiber MD, Goodwin M (2006) Approaches to end-of-life decision-making in the NICU: insights from Dostoevsky’s The Grand Inquisitor. J Perinatol 26:389–391CrossRefGoogle Scholar
  28. Pignotti MS, Donzelli G (2008) Perinatal care at the threshold of viability: an international comparison of practical guidelines for the treatment of extremely preterm births 121(1);e193–198.Google Scholar
  29. Rebagliato M, Cuttini M, Broggin L et al (2000) Neonatal end-of-life decision making: physicians’ attitudes and relationship with self-reported practices in 10 European countries. JAMA 284(19):2451–2459CrossRefGoogle Scholar
  30. Stoll BJ, Hansen NI, Bell EF, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network et al (2010) Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrica 126(3):443–456CrossRefGoogle Scholar
  31. Verhagen AA, Sauer PJ (2005) End-of-life decisions in newborns: an approach from the Netherlands. Pediatrica 116:736–739CrossRefGoogle Scholar
  32. Viner J (1925) The utility concept in value theory and its critics. J Pol Econ 33:369–387CrossRefGoogle Scholar
  33. Watchko JF (1986) The tragic vision: acknowledging limits and uncertainty. J Perinatol 6(1):39–43Google Scholar
  34. Williams C, Cairnie J, Fines V, Patey C et al (2009) Construction of a parent-derived questionnaire to measure end-of-life care after withdrawal of life-sustaining treatment in the neonatal intensive care unit. Pediatrica 123(1):e87–e95CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of PediatricsDrexel University College of Medicine, St. Christopher’s Hospital for ChildrenPhiladelphiaUSA

Personalised recommendations