Summary proceedings from the neonatal pain-control group
Humans; infant; United States; Pain; Pain Measurement; Respiration; Analgesia; Research Support; U.S. Gov't; Newborn; Pain/drug therapy/etiology; Government Regulation; Anesthesia; N.I.H.; Postoperative/drug therapy; Non-P.H.S.; Extramural; General; Outcome Assessment (Health Care)/methods; Artificial/adverse effects; Clinical Trials/ethics/legislation & jurisprudence
Recent advances in neurobiology and clinical medicine have established that the fetus and newborn may experience acute, established, and chronic pain. They respond to such noxious stimuli by a series of complex biochemical, physiologic, and behavioral alterations. Studies have concluded that controlling pain experience is beneficial with respect to short-term and perhaps long-term outcomes. Yet, pain-control measures are adopted infrequently because of unresolved scientific issues and lack of appreciation for the need for control of pain and its long-term sequelae during the critical phases of neurologic maturation in the preterm and term newborn. The neonatal pain-control group, as part of the Newborn Drug Development Initiative (NDDI) Workshop I, addressed these concerns. The specific issues addressed were (1) management of pain associated with invasive procedures, (2) provision of sedation and analgesia during mechanical ventilation, and (3) mitigation of pain and stress responses during and after surgery in the newborn infant. The cross-cutting themes addressed within each category included (1) clinical-trial designs, (2) drug prioritization, (3) ethical constraints, (4) gaps in our knowledge, and (5) future research needs. This article provides a summary of the discussions and deliberations. Full-length articles on procedural pain, sedation and analgesia for ventilated infants, perioperative pain, and study designs for neonatal pain research were published in Clinical Therapeutics (June 2005).
2006
Anand KJ; Aranda JV; Berde CB; Buckman S; Capparelli EV; Carlo W; Hummel P; Johnston CC; Lantos J; Tutag-Lehr V; Lynn AM; Maxwell LG; Oberlander T; Raju TN; Soriano SG; Taddio A; Walco GA
Pediatrics
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1542/peds.2005-0620C" target="_blank" rel="noreferrer">10.1542/peds.2005-0620C</a>
Termination of nutrition and hydration in a child with vegetative state
Female; Humans; Parents; Withholding Treatment; Euthanasia; Dissent and Disputes; Group Processes; Enteral Nutrition; Death and Euthanasia; decision making; infant; Brain Diseases; Child Abuse Amendments 1984; Clinical; Coma/etiology/therapy; Connecticut; Ethics Committees; Federal Government; Government Agencies; Government Regulation; Hartford Hospital (CT); Passive/legislation & jurisprudence; Right to Die/legislation & jurisprudence; Status Epilepticus/complications
A child in a vegetative state may present difficult decisions for physicians and families regarding the course of treatment. We report a case of a child who entered a prolonged vegetative state following status epilepticus. The child's parents requested termination of artificial means of nutrition and hydration. That request culminated in a complex legal intervention by multiple state agencies and attracted local media attention. This article presents the details of the case and discusses the medical and legal complexities encountered. The diagnosis and prognosis of the persistent vegetative state in children have recently been defined. Decision making in these circumstances should be based on adequate, careful clinical evaluation of the medical facts. Hospital ethics committees can provide an independent forum in which the diverse viewpoints in a case may be examined. Decision making should optimally be accomplished between families and caretakers.
1994
Leicher CR; DiMario FJ
Archives Of Pediatrics & Adolescent Medicine
1994
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1001/archpedi.1994.02170010089021" target="_blank" rel="noreferrer">10.1001/archpedi.1994.02170010089021</a>