Document Detail

Decision-making: initiation and withdrawing life support in the asphyxiated infants in developing countries.
MedLine Citation:
PMID:  11811605     Owner:  NLM     Status:  MEDLINE    
The issues of life support in the asphyxiated infant are not only whether cardiopulmonary resuscitation or CPR will be successful, but also whether if successful, the infant will be severely damaged. This is particularly important in the developing countries because the damaged infants may burden the society. The country has to allocate huge financial and human resources to look after them. When it comes to decisions in initiation and withdrawal of life support, there are differences between the East and the West. Physicians are searching for reliable predictors of outcome of term asphyxiated infants to enable early decision-making, initiation and withdrawal life support, as well as counselling and planning appropriate level of treatment including trials of cerebroprotective therapies. Markers commonly used to identify birth asphyxia are not good predictors of brain injury or death. There is a myriad of reports on clinical or laboratory tests, some using single parameter, to help determine neurological outcome of asphyxiated term infants. Much frequently used equipment in developed countries can be expensive and inaccessible to developing countries. There is an urgent need to look for relevant, simple and inexpensive methods. A combination of measurements may look promising in the early selection of at-risk neonates for decision and counselling. Recently measurement of urinary lactate: creatinine ratio to identify early newborn infants at risk for HIE was proposed. Withdrawal of life support is an ethical issue. In withdrawing life support of the severely asphyxiated infants, one must be aware of the differences of approach. There are differences in religion and culture; in beliefs and philosophies, between the East and West The importance of neonatal resuscitation should be emphasised. Some regions still adhere to obsolete resuscitation methods. Neonatal Resuscitation Program (NRP) should be promulgated and organised resuscitation should be introduced. There is an urgent need to train the trainers in CPR in the developing countries.
N K Ho
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Singapore medical journal     Volume:  42     ISSN:  0037-5675     ISO Abbreviation:  Singapore Med J     Publication Date:  2001 Sep 
Date Detail:
Created Date:  2002-01-28     Completed Date:  2002-03-04     Revised Date:  2009-11-03    
Medline Journal Info:
Nlm Unique ID:  0404516     Medline TA:  Singapore Med J     Country:  Singapore    
Other Details:
Languages:  eng     Pagination:  402-5     Citation Subset:  IM    
KK Women's & Children's Hospital, Singapore.
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MeSH Terms
Asphyxia Neonatorum / therapy*
Decision Making*
Developing Countries*
Euthanasia, Passive*
Hypoxia-Ischemia, Brain / diagnosis
Infant, Newborn
Life Support Care

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