Selective resuscitation in premature twins: an ethical analysis

J Perinatol. 2009 Jul;29(7):479-82. doi: 10.1038/jp.2009.44.

Abstract

Selective resuscitation refers to the practice of providing resuscitative efforts to one or some (but not all) infants born in the setting of multiple gestation. When one fetus is known to have a severe anomaly or severe growth restriction, parents are sometimes offered this option. In the setting of extreme prematurity, in the absence of an anomaly or severe growth restriction, parents are generally expected to make one unified decision for all the infants involved. The introduction of the Outcome Estimator, a tool that provides the ability to make individual outcome predictions for each fetus in a multiple gestation at borderline gestational age, based on contributing variables such as weight and gender, has led to the ethical dilemma of whether parents in this setting should also be offered the option of selective resuscitation. No convincing ethical argument for denying the parents the right to decide for each individual infant is apparent.

Publication types

  • Editorial

MeSH terms

  • Decision Support Systems, Clinical / ethics*
  • Female
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Infant, Premature, Diseases / therapy*
  • Male
  • Parents*
  • Pregnancy
  • Pregnancy Trimester, Second
  • Resuscitation Orders / ethics*
  • Twins*
  • Withholding Treatment / ethics*