Hersher Institute: Module on Ethical Reasoning in Developmental Disabilities

NICU: Case Scenario

Mom X was a single White female with a history of poor prenatal care and of drug use. She was admitted in preterm labor at 34 weeks gestation with preterm premature rupture of membranes and meconium-stained amniotic fluid. Due to a breech presentation, an urgent Cesarean delivery was performed. Immediately after delivery, Baby X was intubated due to poor respiratory effort. Baby X weighed 2,200 g and was noted upon delivery to have contractures of upper and lower extremities, a club foot, and microcephaly. Baby X was admitted to the NICU and placed on a ventilator for respiratory support. Baby X received intravenous fluids for nutrition and Fentanyl for sedation/pain. A head ultrasound showed minimal cerebral development with enlarged ventricles. The CT scan showed severe bilateral diffuse cortical thinning with enlarged lateral ventricles and extra axial spaces.

Mom X met with the neonatologist in the NICU to discuss the poor prognosis for survival for Baby X. Mom X wasgiven the option of taking Baby X off the ventilator but was not ready to make that final decision. The perinatal palliative care team, made up of the neonatologist chaplain, social worker, and several NICU and Labor and Delivery (L&D) nurses, was consulted about Mom X and Baby X. Each member provided support to this single mom who had no family or friends to turn to for help or comfort. Over the course of Baby X's 5-day hospital stay daily discussions were held to keep Mom X up to date and involved in Baby X's care.

*Based on: Kauffman, S. & Hauck, C. (2010). Palliative Care in the NICU: A Case Study. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 39, Issue Supplement s1, 1-136. DOI: 10.1111/j.1552-6909.2010.01124_4.x

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