Should Extremely Premature Babies Get Ventilators During the COVID-19 Crisis?

In a crisis, societal needs take precedence over a patient’s best interests. Triage guidelines, however, differ on whether limited resources should focus on maximizing lives or life-years. Choosing between these two approaches has implications for neonatology. Neonatal units have ventilators, some adaptable for adults. This raises the question of whether, in crisis conditions, guidelines for treating extremely premature babies should be altered to free-up ventilators. Some adults who need ventilators will have a survival rate higher than some extremely premature babies. But surviving babies will likely live longer, maximizing life-years. Empiric evidence demonstrates that these babies can derive significant survival benefits from ventilation when compared to adults. When “triaging” or choosing between patients, justice demands fair guidelines. Premature babies do not deserve special consideration; they deserve equal consideration. Solidarity is crucial but must consider needs specific to patient populations and avoid biases against people with disabilities and extremely premature babies.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/155587/1/Should Extremely Premature Babies Get Ventilators During the COVID 19 Crisis.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/155587/3/DeepBluepermissions_agreement-CCBYandCCBY-NC_ORCID NTL 6-11.docxDescription of DeepBluepermissions_agreement-CCBYandCCBY-NC_ORCID NTL 6-11.docx : Deep Blue sharing agreemen

Conjoined twins: an obstetrician\u27s guide to prenatal care and delivery management

OBJECTIVE: Obstetricians infrequently encounter conjoined twins. Much of the clinical care literature focuses on postnatal management from a neonatology and pediatric surgery perspective; guidance on obstetrical management is limited. We outline steps for prenatal evaluation, obstetrical care, and delivery planning. STUDY DESIGN: Experiences with two cases of conjoined twins. RESULTS: We identified several points throughout the planning, delivery, and postnatal process that are important to highlight for optimizing clinical outcome, patient safety, and parental satisfaction. CONCLUSION: After diagnosis, patients should be referred to a center experienced in the management of conjoined twins. Specialists in fields including maternal fetal medicine, pediatric surgery, neonatology, and radiology play a vital role in the management of these patients. Early referral allows for timely family counseling and decision-making. Prenatal evaluation beyond the first trimester should include a detailed ultrasound, fetal echocardiogram, and fetal MRI. 3D printed life-sized models can improve delivery planning and patient understanding

The Ethics of Creating a Resource Allocation Strategy During the COVID-19 Pandemic

https://deepblue.lib.umich.edu/bitstream/2027.42/155579/1/Laventhal_et_al.pdfDescription of Laventhal_et_al.pdf : Postprin