Neonatal Care at the Limits of Viability

Last minute decisions are being made by the neonatologists that do not include the parents' wishes. The decisions could be either resuscitating an infant against the parents' wishes or only providing palliative care instead of resuscitation and aggressive treatment despite the parents' wishes. It is suggested that "neonatologists have become self-appointed guardians of the rights of borderline, barely viable neonates and that this decision-making power is trumping the competing rights of families and societies" (Kaempf et al. 23). Neonatologists have taken it upon themselves to make the final decision for these tiny lives that are just holding on.
             The most decisive factor in deciding neonatal care is gestational age. AAP has set guidelines that specify that resuscitation should not be attempted for a child born before 24 weeks gestation. However, determining the actual gestation age is not an exact science. When calculating an expectant mother's estimated date of delivery (EDD), doctors typically begin counting from the first day of her last menstrual period (LMP). While this method has been the standard way of calculating EDD, this method is not appropriate for all women, especially those with irregular cycles. As supported in What to Expect When You're Expecting, doctors have stated that if women with irregular periods were to conceive, there is no way to accurately know the date of conception (Murkoff 8). Several other factors will need to be taken into consideration to guess the gestational age, including size of uterus. As pregnancy progresses, other signs will help indicate the gestational age, but it will still only be an estimate. With all estimates and signs, neonatologists have stated that making neonatal care before the actual birth and assessment of the child, is simply "speculation" (Paris et al.341). A complete and accurate assessment of gestational age, and overall health of an infant, can only be determined at birth.