Demystifying the ED to Integrate Palliative Care Programs (507)

Abstract

morbidity and mortality in extremely low birthweight infants. 2. Examine legal decisions in resuscitation at the threshold of viability and in cases of neonatal medical futility. 3. Evaluate current practice in neonatal palliative care and appraise opportunities for perinatal hospice. Neonatal viability invokes passionate opinions and ethical debate within the medical community. This session will serve to build judgment more rooted in a framework of evidence, ethics, and legal responsibility, while accounting for the psychosocial values of parents. The principles of distributive justice, beneficence, autonomy, and nonmaleficence will provide the framework to review the clinical circumstances facing providers who care for the extremely low birthweight (ELBW) infant. The threshold of viability is defined as infants born at 22e25 weeks gestation by the American Academy of Pediatrics. Resuscitation guidelines for this period of viability range dramatically. In considering this variation, published morbidity, mortality, and neurodevelopmental outcomes often drive the intensive care decision making for these critical neonates. The NICHD Neonatal Research Network has demonstrated 54% of 500e750 gram infants survive, with only 37% showing evidence of a morbidity-free life. The EPICure Study illustrated 48% of survivors exhibit disability at 30months of age. Recent studies reflect that decision making to resuscitate the ELBW infant is rooted in parental autonomy; however, despite consistent prenatal counseling by neonatologists regarding clinical concerns, there is tremendous disparity when discussing social andethicalmatters. Paradigm legal cases including the Sydney Miller Case in Houston Texas have helped define legal implications in emergency decision making for the high-risk neonate. Such legislation as the Born-Alive Infants Protection Act, as well as obstetric literature that cites inaccurate gestational dating, indicate that distinct barriers exist regarding the accuracy of predicting neonatal outcomes. Diagnostic criteria for palliative care referrals in the neonatal ICU primarily includes extreme prematurity or catastrophic illness. Reasons for consultations often focus on the organization of home hospice and facilitation of medical options. These factors establish a considerable need for perinatal palliative care and hospice in the care of neonates at the threshold of viability. Domain Physical Aspects of Care; Ethical and Legal Aspects of Care