1 pointI just want to share the link to the e-book "MRI of the neonatal brain", freely available on the web site www.mrineonatalbrain.com The content was printed as a book in 2001, but is out of print. Professor Mary Rutherford who edited the book wrote to me: My thanks to Sutirtha Roy who shared this link in a comment to the Leading article about how cranial ultrasound correlate with MRI findings.
1 pointThis article describes the detailed project aimed to realize a dedicated ground ambulance for neonatal emergency transport service (NETS). https://ijponline.biomedcentral.com/articles/10.1186/s13052-019-0686-y
1 pointI fear I may have exposed myself poorly. My concern is less with a ceiling (which implies that I am opposed to escalating levels of care) as opposed to walls or boundaries. By this I mean, my concern is that we sometimes offer families options which have no realistic hope of helping the family achieve their goals of care all because we do not wish to be paternalistic.
1 pointI believe parents must always have a choice with as much as we can give them. There is subjectivity in a lot of our interpretation. I agree culture and society must and will influence norms. I worry about not offering treatment choices because they are traumatic or may cause suffering. There is then the interpretation of suffering. Do we all agree on an opinion of what is invasive or traumatic. The problem is there is subjectivity to how this is interpreted by different health professionals within a team. You can sell it to parents whatever way you like and actually that becomes the truth for them. The question then is how much suffering is too much suffering. There is then whether the treatment reaches a threshold of harm or whether it is outweighed by the risk of an adverse neurodevelopmental outcome that you can never be definitive about. I find this this very difficult. My main worry about health professionals making decisions in such circumstances is that our fatigue and inability to provide definition to the problem or show ourselves and parents improvement means we call it. That in my opinion is a paternal Approach. I accept your argument that a ceiling is needed and I wonder whether this best done by consensus amongst the team and parents.
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