Center to Advance Palliative Care

For Patients and Families
Partner
Sponsor
 
  Print this page
Views

CAPC Palliative Care Discussion Forum
Pediatric Palliative Care

Next Reply: Brain death for infants less than 37 weeks gest
Previous Message: Appropriate pain management over family objections
Next Message: Needs Assessment Tools

Post removing nutrition & brain death in less than 37we
Author: Meggan
Date: Apr 30, 2012 7:21 am
We have also received a request for policies, guideline, and/or protocols regarding:

1) Determination of brain death in the less than 37 weeks gestation infant

2) withdrawal/withholding of nutrition in the infant and/or pediatric patient

for a developing pediatric ethics committee for another of our members. Any existing material would be welcomed :)
Replies: order by [Date] [Author] [Subject]
+ Brain death for infants less than 37 weeks gest (by Lustbader on 04/30/2012)
New York State Dept of Health issued brain death guidelines in 2011 to reflect best practice. This state guideline is also the policy our 15 hospital health system follows. Reliable criteria have not been established for infants less than 7 days old or those not full term however our practice would be to wait 48 hours between two examinations in those cases.

"Determination of Brain Death in Children Less Than One Year of Age
1. General Policy Statement.
The brains of infants and young children have increased resistance to damage and may recover substantial functions even after exhibiting unresponsiveness on neurological examination for longer periods as compared to adults. When applying neurological criteria to determine death in children younger than one year, longer waiting periods are required.
2. The patient must not be significantly hypothermic or hypotensive for age.
3. Waiting Periods According to Age.
The recommended waiting period depends on the age of the patient and the laboratory tests utilized. Ages listed assume the child was born at full term. Between the ages of 2 months and 1 year, an interval of at least 24 hours should be used. Between the ages of 7 days and 2 months, the minimum interval should be 48 hours.
• Reliable criteria have not been established for the determination of brain death in children less than 7 days old.
• Seven days to two months: Two examinations and electroencephalograms (EEGs) should be separated by at least 48 hours.
• Two months to one year: Two examinations and EEGs should be separated by at least 24 hours. A repeat examination and EEG are not necessary if a concomitant radionuclide or other angiographic study demonstrates no visualization of cerebral arteries.

I am happy to share our policy with you.

Dana Lustbader MD

IMPORTANT: In order to post a new message or reply to an existing post in the discussion you must login. If you are not a registered member you may join here.
The statements posted in the forum section of capc.org are opinions expressed by website visitors and do not necessarily represent the viewpoints or positions of the Center to Advance Palliative Care(CAPC). CAPC is not responsible for the factual or legal accuracy of any of the statements posted.


General questions about using the CAPCconnect™ palliative care discussion forum?
Email: Jennifer.Raiten@mssm.edu

Lost login username/password questions? Email: Margaret.Schutz@mssm.edu