The Process of Assembling A Prognosis in Nicu

Abstract

The uncertainty of prognosis and the importance of prognosis are in tension with one another, especially in modern neonatal intensive care units (NICU). Prognosis, along with diagnosis, forms the cornerstone of making decisions. Reaching a shared consensus often happens without the participants being fully aware of the process. Child psychiatrists can be helpful in a team to make explicit where the team, the family and the outside specialist teams are up to in arriving at consensus and how they might move beyond times of impasse. Child psychiatrists have not traditionally had a large role in NICU except in relation to the adult mental health. This paper emerged from two child psychiatrists, both pediatric neuropsychiatrists, quietly “observing” and describing the everyday business of a NICU. It elucidates the process of how NICU clinicians in one children’s hospital, and the families they care for, arrive at a consensus despite the uncertainties and the complexities. What is extraordinary is that this process is usually managed without complication.