Background: Improvements in diagnostics and treatment have made it possible to save more premature and critically ill newborn infants as well as infants born with severe congenital anomalies. However, some of these infants often develop complication with a poor prognosis for survaval and later quality of life. An active decision to withdraw treatment is often made in such cases. The process of such decisions are, however, often weakly structured and regulated with respect to; who makes the decision, how and when are such decisions taken, and which ethical platform is used. In most cases the etical considerations are based on a combination of duty based and consequence based ethics. In such cases a decision-theoretical approach migh be useful in the decision process.Methods: The decision-theoretical approach takes into account; who are the persons who will be affected by the decision (infant, parents, staff), what are the different alternatives (continue treatment, extubate), what are the consequences of these alternatives (death, severe handicap), what is the possibility that these consequences will happen (very likely, not likely), and what is the value of these consequences (positive or negative). On this background a decision theoretical approach was used in the evaluation of treatment of a case report of a critically ill newborn infant, where the parents had asked for the treatment to be stopped. The treatment alternatives were considered to be; continue full treatment, immediately extubate, and, continue treatment at present level but not escalate to treat deteriorations or complications.Results: The analysis showed that considering both the infant and the parents, to continue treatment at the present level came out as the best alternative, with immediate extubation as the the second best. The best alternative for the infant alone was, however, to continue full treatment. The best alternative for the medical staff would be to extubate the infant to die. For all parts (infant, parents, staff) the best decision would be to continue treatment at the present level.Conclusion: A decision-theoretical approach is useful by its possibility to highlight the different elements which the final decision will be based upon. It will therefore make the decision takers more conscious about the basis for their decision and illustrate how differences in evaluation of consequences and their values might explain any disagreements between the different persons who will be responsible for the final decision.
COMPARISON OF CRIB SCORE AND SNAPPE-II SCORE AS PREDICTORS OF MOR-TALITY AND MORBIDITY IN PREMATURE INFANTS WITH BIRTHWEIGHT < 1501 GRAMS S L Brattli, D Bratlid St. Olav University Hospital, Department of Pediatrics, Trondheim, NorwayBackground:Neonatal risk scoring systems are designed to predict illness severity and mortality through observations made shortly after birth. The two systems CRIB score and SNAPPE-II score have previously not been compared applied to very low birth weight (VLBW) and extremely low birth weight (...
