title: [The practices of withdrawing artificial nutrition and hydration in the neonatal intensive care unit: a preliminary study].
abstract: BACKGROUND
  Prematurity is one of the etiologies for severe neurological complications. Decisions to withdraw therapeutics, including artificial nutrition and hydration (ANH), are sometimes discussed. But can one withdraw ANH if the patient is a child suffering from severe neurological conditions, based on his best interests? The aim of this study was to further the understanding of the complexity of the withdrawal of ANH and its implementation in the neonatal intensive care unit (NICU).
  
  
  METHODS
  This qualitative preliminary study based on a questionnaire was conducted on the staff in the NICU of the Pontoise medical center (France) in February 2012. The results were compared with the current knowledge on this issue and sociological data.
  
  
  RESULTS
  Ten of the hospital staff members responded to the questionnaire: 60% considered ANH as a treatment, but the status of ANH (i.e., treatment or care) remained undefined for several respondents. Comparison with the withdrawal of mechanical ventilation or adult practices seemed to be inadequate. The staff had little experience in the domain and therefore few certainties on practices. Half of the respondents indicated that terminal sedation needed to be used. For the other half, it depended on the patient's pain. Timing was also an important notion given that the newborn is a being developing and evolving each in its own way.
  
  
  CONCLUSIONS
  The withdrawal of ANH remains controversial in the NICU. Humanity, culture, and the relationship to others are ever present in the decision-making process, creating a moral opposition above and beyond ethical reflection.
authors.affiliation: Laboratoire d'éthique médicale et de médecine légale, hôpitaux de Paris, université Paris-Descartes, 45, rue des Saints-Pères, 75006 Paris, France. Electronic address: agathe.beranger@gmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Béranger
authors.affiliation: Réanimation néonatale, centre hospitalier René-Dubos, 6, avenue de l'Île-de-France, BP 79, 95303 Cergy-Pontoise cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Boize
authors.affiliation: EA 4596 « politique, éthique, santé », Paris-Descartes, Sorbonne Paris Cité, 45, rue des Saints-Pères, 75006 Paris, France; Équipe mobile d'accompagnement et de soins palliatifs pédiatrique et adulte, Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.
authors.forename: M-L
authors.initials: ML
authors.lastname: Viallard
mesh_terms: D001291:Attitude of Health Personnel; D001925:Brain Damage, Chronic / Q000401:mortality / Q000628:therapy*; D004992:Ethics, Medical; D004993:Ethics, Nursing; D028601:Euthanasia, Active / Q000941:ethics; D005440:Fluid Therapy / Q000941:ethics*; D005602:France; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000401:mortality / Q000628:therapy*; D007363:Intensive Care Units, Neonatal / Q000941:ethics*; D018529:Nutritional Support / Q000941:ethics*; D010166:Palliative Care / Q000941:ethics; D010348:Patient Care Team / Q000941:ethics; D010865:Pilot Projects; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D028761:Withholding Treatment / Q000941:ethics*