title: Integrating neurocritical care approaches into neonatology: should all infants be treated equitably?
abstract: To improve the neurologic outcomes for infants with brain injury, neonatal providers are increasingly implementing neurocritical care approaches into clinical practice. Term infants with brain injury have been principal beneficiaries of neurologically-integrated care models to date, as evidenced by the widespread adoption of therapeutic hypothermia protocols for hypoxic-ischemic encephalopathy. Innovative therapeutic and diagnostic support for very low birth weight infants with brain injury has lagged behind. Given that concern for significant future neurodevelopmental impairment can lead to decisions to withdraw life supportive care at any gestational age, providing families with accurate prognostic information is essential for all infants. Current variable application of multidisciplinary neurocritical care approaches to infants at different gestational ages may be ethically problematic and reflect distinct perceptions of brain injury for infants born extremely premature.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA, USA.|Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.
authors.forename: P C
authors.initials: PC
authors.lastname: Mann
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA, USA.|Department of Neurology, University of Washington, Seattle, WA, USA.|Division of Neurology, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Gospe
authors.affiliation: Department of Neurology, University of Washington, Seattle, WA, USA.|Division of Neurology, Seattle Children's Hospital, Seattle, WA, USA.
authors.forename: K J
authors.initials: KJ
authors.lastname: Steinman
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA, USA.|Treuman Katz Center for Pediatric Bioethics, Seattle Children's Research Institute, Seattle, WA, USA.
authors.forename: B S
authors.initials: BS
authors.lastname: Wilfond
mesh_terms: D003657:Decision Making; D004453:Echoencephalography; D005260:Female; D005865:Gestational Age; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D020925:Hypoxia-Ischemia, Brain / Q000628:therapy; D007223:Infant; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D055048:Integrative Medicine / Q000379:methods*; D015931:Intensive Care, Neonatal / Q000592:standards*; D008279:Magnetic Resonance Imaging; D008297:Male; D009359:Neonatology / Q000379:methods*; D065886:Neurodevelopmental Disorders / Q000175:diagnosis* / Q000628:therapy*; D011247:Pregnancy; D016896:Treatment Outcome