When newborn infants are bound to die

Abstract

Withholding and withdrawing of intensive care of severely ill newborns may occasionally be needed when there is severe injury and extremely poor prognosis. In such cases, strict guidelines and procedures should be followed. In this issue of Acta Paediatrica, Arlettaz et al. describe such guidelines and report practice from the University Hospital in Zürich. To ensure an unbiased discussion, it is important that those who make decisions regularly receive input from external sources regarding indications of viability. This may be the case if, for instance, a unit has decided that the limit of viability is <26 wk, and many children with good life expectancy would in such units be denied intensive care. Does a liberal view on withholding or withdrawing treatment lead to poorer overall outcome results even for babies above the threshold of viability specified by the institution?

Conclusion: Strict procedures should be followed in the case of withholding or withdrawing intensive care of severely ill newborn infants. In every institution, the indications for ending life should be discussed on a regular basis, preferably with external input. However, euthanasia of newborn infants is not compatible with Western cultural traditions and should be abandoned.