Neonatal Intensive Care Unit: Ethical Dilemmas

Sustainable Development Goal (SDG) is targeted for neonatal mortality. For Bangladesh, it is 12 per 1000 live births. Emphasis is being given on neonatal service at community as well as in facility level. Development of Special Care Newborn Unit (SCANU) and Neonatal Intensive Care Unit (NICU) is emphasized. A NICU is a specialized center for ill or premature newborn infants, typically directed by a neonatologist and staffed by nurses, resident physicians and other supporting staffs. The American Academy of Pediatrics (AAP) updated their policy statement of neonatal care into level-1, level-II (SCANU) and level-III (NICU) care. The care is intensified by advancement in NICU. But it is challenging from very premature, congenitally malformed and critically ill newborn infant. Parents smile from favorable outcome of sick infant from promising treatment in NICU. But sometimes it may invite unwanted sufferings and push parents into expensive financial burden. It is difficult to decide whether to do nothing or to do everything for a critically ill infant. Numerous ethical issues and conflicts in decision-making in such service are existent. The issues are related to dependent neonate, uncertain outcome, potential trauma, prolonged support, absence of established guidelines, increasing costs, organization of SCANU and emotional aspect. Basic principles of biomedical ethics in terms of autonomy, beneficence, nonmaleficence and justice need to be addressed. Decision for the best interest of newborn infant is based on perception of parents, medical staff and related others. Help from established guidelines and policies in case of unclear decision are crucial. Rational process and staff-friendly environment in NICU is essential for ethical decision making by the ethical team. Key words: Ethical Dilemma, Decision Making, Neonate, Intensive Care Unit.