Severe ischaemic gangrene of scalp in an extreme preterm: a fatal case of combined aetiology

2021 ◽  
Vol 14 (1) ◽  
pp. e236375
Author(s):  
Antonio Pérez-Iranzo ◽  
Vicente Olaya Alamar ◽  
Luz M Mira Ferrer ◽  
Andrea Nos Colom
Keyword(s):  
Caesarean Section ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Fatal Case ◽  
High Dose ◽  
Uterine Contractions ◽  
Scalp Lesion ◽  
Withdraw Life Support ◽  
Manual Manipulation ◽  
Preterm Rupture Of Membranes

A 24+5-week preterm neonate with a severe scalp lesion was admitted to the neonatal intensive care unit (NICU) after caesarean section due to maternal chorioamnionitis (MC). An Arabin pessary had been inserted in addition to a previous cervical cerclage due to cervix insufficiency at 21+5 weeks of pregnancy (wp). At 23+5 wp, preterm rupture of membranes was evidenced. Both devices were kept to provide fetal viability. On 24+4 wp, she developed MC. Urgent caesarean section was performed. Transvaginal manual manipulation was required during the procedure. On NICU, she presented severe shock which required high-dose vasopressors and blood products. Following surgical repair, a bilateral grade IV intracranial haemorrhage was evidenced. Subsequently, it was agreed to withdraw life support. We hypothesise that MC and local infection could have acted as predisposing factors, with the presence of a pessary in the setting causing uterine contractions and its manipulation acting as a precipitating factor.

67. Loving your child to death: Considerations of the care of chronically-ill children and euthanasia in Emil Sher's Mourning Dove and implications for medical educations

2007 ◽  
Vol 30 (4) ◽  
pp. 65
Author(s):  
K. Mukhida
Keyword(s):  
Life Support ◽  
Terminally Ill ◽  
Chronically Ill ◽  
Legal Aspects ◽  
Mourning Dove ◽  
Medical Professionals ◽  
Constant Pain ◽  
Withdraw Life Support ◽  
Wheat Farmer

How do parents cope when their child is ill or dying, when he or she experiences constant pain or suffering? What do parents think of the contributions that medical professionals make to the care of their chronically or terminally ill child? Is it possible for a parent to love a child so much that the child is wished dead? The purpose of this paper is to explore those questions and aspects of the care of chronically or terminally ill children using Mourning Dove’s portrayal of one family’s attempt to care for their ill daughter. A play written by Canadian playwright Emil Sher, Mourning Dove is based on the case of Saskatchewan wheat farmer Robert Latimer who killed his 12 year old daughter Tracy who suffered with cerebral palsy and lived in tremendous pain. Rather than focusing on the medical or legal aspects of the care of a chronically ill child, the play offers a glimpse into how a family copes with the care of such a child and the effects the child’s illness has on a family. Reading and examination of non-medical literature, such as Mourning Dove, therefore serve as a useful means for medical professionals to better understand how illness affects and is responded to by patients and their families. This understanding is a prerequisite for them to be able to provide complete care of children with chronic or terminal illnesses and their families. Nuutila L, Salanterä S. Children with long-term illness: parents’ experiences of care. J Pediatr Nurs 2006; 21(2):153-160. Sharman M, Meert KL, Sarnaik AP. What influences parents’ decisions to limit or withdraw life support? Pediatr Crit Care Med 2005; 6(5):513-518. Steele R. Strategies used by families to navigate uncharted territory when a child is dying. J Palliat Care 2005; 21(2):103-110.

scholarly journals Ethical Issues around Death and Withdrawal of Life Support in Neonatal Intensive Care

2021 ◽  
Author(s):  
Stuti Pant
Keyword(s):  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Ethical Issues ◽  
Ethical Dilemmas ◽  
Human Life ◽  
Traumatic Experiences ◽  
National Guidelines ◽  
Brain Injured ◽  
Discharge Against Medical Advice

AbstractAmongst all the traumatic experiences in a human life, death of child is considered the most painful, and has profound and lasting impact on the life of parents. The experience is even more complex when the death occurs within a neonatal intensive care unit, particularly in situations where there have been conflicts associated with decisions regarding the redirection of life-sustaining treatments. In the absence of national guidelines and legal backing, clinicians are faced with a dilemma of whether to prolong life-sustaining therapy even in the most brain-injured infants or allow a discharge against medical advice. Societal customs, vagaries, and lack of bereavement support further complicate the experience for parents belonging to lower socio-economic classes. The present review explores the ethical dilemmas around neonatal death faced by professionals in India, and suggests some ways forward.

Resuscitation and Withdrawal of Therapy in Pediatric Intensive Care

PEDIATRICS ◽  
1992 ◽  
Vol 89 (5) ◽  
pp. 961-963
Author(s):  
RICHARD B. MINK ◽  
MURRAY M. POLLACK
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Life Support ◽  
Pediatric Intensive Care ◽  
New Haven ◽  
Hammersmith Hospital ◽  
Hospital Deaths ◽  
Withdrawal Of Therapy ◽  
Haven Hospital

Although issues concerning withdrawal and limitation of life support are commonly discussed,1-6 actual practices in pediatrics are largely unknown and are limited to neonatal intensive care unit (ICU) studies. In the neonatal ICUs at Yale-New Haven Hospital and at Hammersmith Hospital, 14% and 30%, respectively, of all deaths followed withdrawal of care.7,8 In adult ICUs, limitation and/or withdrawal of therapy is common,9 and in one investigation, resuscitation was not attempted immediately before ICU death in nearly two-thirds of cases.10 Nonetheless, many physicians believe that most hospital deaths occur only after all resuscitative attempts have failed,6,11,12 and others believe that resuscitative efforts neither are indicated nor desirable in many cases.1,13

STUDY OF THE EFFECT OF GENERALAND REGIONALANESTHESIA ON FOETOMATERNAL OUTCOME IN WOMEN UNDERGOING CAESAREAN SECTION FOR SEVERE PREECLAMPSIA

2021 ◽  
pp. 77-79
Author(s):  
Ashok Das ◽  
Suman Chattopadhyay ◽  
Manas Karmakar
Keyword(s):  
Critical Care ◽  
Caesarean Section ◽  
General Anaesthesia ◽  
Neonatal Intensive Care ◽  
Severe Preeclampsia ◽  
Study Cohort ◽  
Human Right ◽  
Medical College ◽  
Development Goals ◽  
Neonatal Care Unit

INTRODUCTION Motherhood is the ultimate joy in a woman's life. Every woman craves for her own child. However, more than half a million 1 women die each year from pregnancy related causes across the globe. The United Nations Millennium Development Goals has placed maternal health as a basic human right, one that is integral to the core of the ght against poverty and inequality. The high incidence of preeclampsia and its complications makes its prevention and effective management important. AIMS AND OBJECTIVES To study the effect of anaesthetic technique in the foetomaternal outcome in severe preeclamptic patients undergoing caesarean section and determining any difference in the maternal and perinatal morbidity/mortality amongst those receiving either general or regional anaesthesia. MATERIALS AND METHODS Study Area: Eden Hospital, Critical Care Unit (CCU), Special Neonatal Care Unit (SNCU), and Neonatal Intensive Care Unit (NICU) of Medical College & Hospital, Kolkata. Study Population: Mothers and babies of severe preeclamptic patient with 34 or more gestational weeks admitted in Eden Hospital, Medical College & Hospital, Kolkata undergoing caesarean section formed our study cohort. Study Period: 18 months (from February 2012 till June 2013). RESULTS AND OBSERVATIONS The patients of severe preeclampsia were in the age group 18 to 30 years (93 %). Only 1.2 % were aged more than 40years. 5.8 % of patients were between the ages of 30 to 40 years. The age patterns were similar in both the groups receiving either spinal or general anaesthesia. SUMMARY AND CONCLUSION Severe preeclampsia mothers receiving general anaesthesia and their babies required more critical care support. Maternal as well as neonatal mortality was signicantly higher with general anaesthesia. Spinal anaesthesia is safer alternative to general anaesthesia in severe preeclampsia with less post operative morbidity and mortality

scholarly journals Impact of cesarean section on transient tachypnea of the newborn: a longitudinal study

2021 ◽  
Vol 8 (3) ◽  
pp. 467
Author(s):  
Keziah Joseph ◽  
Bhargavi B. ◽  
C. S. Jain ◽  
Dasaradha Rami Reddy
Keyword(s):  
Caesarean Section ◽  
Respiratory Distress ◽  
Neonatal Intensive Care ◽  
Clinical Course ◽  
Mode Of Delivery ◽  
Normal Vaginal Delivery ◽  
Medical Sciences ◽  
Benign Condition ◽  
Term Neonates ◽  
Early Onset Sepsis

Background: Transient tachypnea of the new born is a benign condition. The aim of the study is to find any correlation between the mode of delivery and occurrence of transient tachypnea of newborn.Methods: Study is proposed to assess the risk factor like caesarean section and its relationship with occurrence of TTN in term neonates and the clinical course of TTN cases admitted in Neonatal intensive care unit (NICU), Department of Pediatrics, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda, Telangana.Results: During the study period, total number of deliveries in our hospital was 4576. Of 356 term neonates with respiratory distress admitted in NICU, the most common cause was found to be early onset sepsis i.e 168 of 356 cases accounting for 47.19%, followed by transient tachypnea of newborn i.e., 68 of 356 cases accounting for 19.10%.Conclusions: The mode of delivery i.e caesarean section has a significant impact on transient tachypnea of newborn (TTN) with a relative risk of 3.78 compared to normal vaginal delivery. The majority of cases had mild respiratory distress and were relieved of symptoms within 3 days of hospital stay.

Biases in how physicians choose to withdraw life support

The Lancet ◽  
1993 ◽  
Vol 342 (8872) ◽  
pp. 642-646 ◽  
Author(s):  
N.A. Christakis ◽  
D.A. Asch ◽  
N.A. Christakis ◽  
D.A. Asch
Keyword(s):  
Life Support ◽  
Withdraw Life Support

Paediatrics

2020 ◽  
pp. 178-319
Author(s):  
Simon Buckley
Keyword(s):  
Cystic Fibrosis ◽  
Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Congenital Heart ◽  
Life Support ◽  
Accidental Injury ◽  
Haemolytic Disease ◽  
Common Illnesses ◽  
Common Problems ◽  
Non Accidental Injury

This chapter in the Oxford Handbook of Clinical Specialties explores the specialty of paediatrics. It discusses emergencies such as life support, anaphylaxis, and cardiac arrest. It explores taking a history, physical examination, and how to deal with fever and common problems, including non-accidental injury. It discusses common viral infection and respiratory issues such as asthma and cystic fibrosis, as well as gastrointestinal and genitourinary issues such as abdominal pain and distension, diarrhoea, malnutrition, malformations, nephrotic syndrome, and renal disease. It explores neurology from epilepsy to headache, and cardiology from congenital heart disease to heart murmurs. It discusses haematology and immunology, endocrinology, and growth. It ends with a detailed discussion of neonatology, from examination to common illnesses, daily requirements to breastfeeding, jaundice to haemolytic disease, and respiratory distress to the neonatal intensive care unit, respiratory support, and sudden unexplained infant death.

Sign in / Sign up

Export Citation Format

Share Document