A Premature Infant With Necrotizing Enterocolitis Whose Parents Are Jehovah's Witnesses

With this article, we introduce a new feature in Pediatrics called “Ethics Rounds.” The goal of this new feature is to present clinical cases that raise ethical issues. We present each case to pediatricians and bioethicists, who comment on the case on the basis of the information that they have at the time. We then give these same commentators the conclusion of the case and ask for further reflections. The case is printed in italic font, and comments are in normal, Roman font. To protect patient privacy, we change certain facts of each case. Thus, although the reports are based on real cases, the names, ages, location, and gender of the patient may be changed if they are not relevant to the central issues of the case. We invite readers to submit cases to the editor of Ethics Rounds: John Lantos, MD (jlantos@cmh.edu). Our first case involves an extremely premature infant who developed necrotizing enterocolitis (NEC). We presented the case, as it evolved, to 2 experienced pediatrician-bioethicists, Dr William Meadow and Dr Chris Feudtner. We then asked another pediatrician-bioethicist, Armand H. Matheny Antommaria, who has training in religious ethics to comment on the case and the discussion. Infant Smith was born at 25 weeks' gestation by emergency cesarean delivery after placental abruption. His birth weight was 475 g. He was stable for the first 4 days. A head ultrasound on day 2 showed a grade II intraventricular hemorrhage on the right. He had oxygen saturation levels of 94% on low ventilator settings. On day 5, Infant Smith experienced a decrease in oxygen saturation and abdominal distension. An abdominal radiograph showed free air in the abdomen. A surgical consult was obtained, and an exploratory laparotomy was scheduled. As part of the consent for surgery, the parents were asked to consent … Address correspondence to John Lantos, MD, Children's Mercy Bioethics Center, Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108. E-mail: jlantos{at}cmh.edu