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Ethical dilemmas of recording and reviewing neonatal resuscitation
  1. Maria C den Boer1,2,
  2. Mirjam Houtlosser2,
  3. Henriëtte Anje van Zanten1,
  4. Elizabeth E Foglia3,
  5. Dirk P Engberts2,
  6. Arjan B te Pas1
  1. 1 Division of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2 Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, The Netherlands
  3. 3 Division of Neonatology, Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
  1. Correspondence to Maria C den Boer, Leiden University Medical Center, Leiden 2300 RC, The Netherlands; m.c.den_boer{at}


Neonatal resuscitation is provided to approximately 3% of neonates. Adequate ventilation is often the key to successful resuscitation, but this can be difficult to provide. There is increasing evidence that inappropriate respiratory support can have severe consequences. Several neonatal intensive care units have recorded and reviewed neonatal resuscitation procedures for quality assessment, education and research; however, ethical dilemmas sometimes make it difficult to implement this review process. We reviewed the literature on the development of recording and reviewing neonatal resuscitation and have summarised the ethical concerns involved. Recording and reviewing vital physiological parameters and video imaging of neonatal resuscitation in the delivery room is a valuable tool for quality assurance, education and research. Furthermore, it can improve the quality of neonatal resuscitation provided. We observed that ethical dilemmas arise as the review process is operating in several domains of healthcare that all have their specific moral framework with requirements and conditions on issues such as consent, privacy and data storage. These moral requirements and conditions vary due to local circumstances. Further research on the ethical aspects of recording and reviewing is desirable before wider implementation of this technique can be recommended.

  • ethics
  • neonatology
  • resuscitation

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  • Contributors All authors made substantial contributions to the intellectual content. MCdB and MH drafted the initial version of the manuscript and all authors participated in critical revision of the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding ABtP is recipient of a NWO Innovational Research Incentives Scheme (VIDI 91716428).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.