Elsevier

Seminars in Perinatology

Volume 27, Issue 6, December 2003, Pages 480-487
Seminars in Perinatology

The ethics of withholding/withdrawing nutrition in the newborn

https://doi.org/10.1053/j.semperi.2003.10.007Get rights and content

Abstract

The provision of nutrition and hydration to newborn infants is considered fundamental care. For premature and critically ill newborns, similar considerations generally hold true. Nutrition may be provided for these infants using assisted measures such as parenteral nutrition or tube feedings. However, for some newborn infants the provision of medically assisted nutrition may be a more complicated issue. In particular, the goals of nutrition need to be clearly elaborated for newborns with lethal conditions or for whom appropriately administered intensive care is unsuccessful in sustaining life. These infants may benefit from palliative measures of care and a limitation or withdrawal of burdensome or nonbeneficial interventions. This article explores issues pertinent to deciding and communicating the appropriate withdrawal of medically assisted nutrition and implementing palliative comfort measures.

Section snippets

Ethical considerations of withdrawing artificially administered nutrition and hydration in adults

Ethical considerations around the provision or withholding of nutrition gained attention in medical practice in the late 1970s and early 1980s. An “emerging stream” of thought that fluids and nutrition could be withheld became apparent, argued around 2 propositions:

  • 1.

    The medical administration of nutrition is a medical intervention, and

  • 2.

    A benefits/burdens calculation was the critical element of judgment about withholding/withdrawing medical interventions (the rule of proportionality).

In an early

Pediatric withdrawal of artificially administered nutrition

The support found in the adult literature that withholding artificially administered nutrition near the end-of-life does not prolong life, may not be true in pediatrics. Certainly, there are pediatric patient populations for whom gastrostomy tube feedings or parenteral nutrition will prolong the life of the child. This may be so, even if the child will ultimately die from their underlying condition. A ready example would be the premature infant with an extremely short gut - perhaps following

Practical strategies in the NICU

Given the occasional necessity to consider the WH/WD of artificially administered nutrition in the NICU, what guidance can be given?

First and foremost, the necessity of maintaining communication between the parents, extended family, and the health care staff must be underscored. All involved should be aware of the infant’s signs and symptoms that may develop with the withdrawal of artificial hydration and nutrition, the time frame over which these will likely appear following withdrawal, and a

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    This work was completed at Vanderbilt University Medical Center in Nashville, TN. B. S. C. is supported in part by a grant from the Initiative for Pediatric Palliative Care, Center for Applied Ethics & Professional Practice, Education Development Center, Inc, Newton, MA.

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