Pediatric Ethics Consultation: Practical Considerations for the Clinical Ethics Consultant.

Clinical ethics consultants face a wide range of ethical dilemmas that require broad knowledge and skills. Although there is considerable overlap with the approach to adult consultation, ethics consultants must be aware of differences when they work with infant, pediatric, and adolescent cases. This article addresses unique considerations in the pediatric setting, reviews foundational theories on parental authority, suggests practical approaches to pediatric consultation, and outlines current available resources for clinical ethics consultants who wish to deepen their skills in this area.

Ethical issues in the care of the neurologically devastated infant.

The debate surrounding neurologically devastated newborns, whether due to severe prematurity or genetic malformations, has continued for over 40 years. Duff and Campbell (1973) first discussed allowing these children to die in the 1970s. In the 1980s, others fought to make sure these children with disabilities were afforded all the rights of other children.

Is repeat head computed tomography necessary in children admitted with mild head injury and normal neurological exam?

Background: Children admitted following mild head injury (MHI) often undergo repeat head computed tomography (HCT) to identify progression of injury, although there is little evidence to support this practice.

Methods: From January 2007 to December 2009, we retrospectively reviewed the medical records of patients aged 2 months to 18 years admitted with a diagnosis of MHI to a Level I Pediatric Trauma Center. Data including Glasgow Coma Scale, loss of consciousness, length of stay (LOS), and number and results of HCTs were analyzed.

Parental views on withdrawing life-sustaining therapies in critically ill children.

Objective: To broaden existing knowledge of pediatric end-of-life decision making by exploring factors described by parents of patients in the pediatric intensive care unit (PICU) as important/influential if they were to consider withdrawing life-sustaining therapies.

Design: Quantitative and qualitative analysis of semi-structured one-on-one interviews.

Setting: The PICUs at 2 tertiary care hospitals.

Parents' reactions to participating in interviews about end-of-life decision making.

Background: Although in-depth interviewing is well suited to studying the sensitive topic of end-of-life decision making, no reports have been published assessing the effects on parents of participating in interviews regarding end-of-life decision making for critically ill children.

Objective: To examine the reactions of pediatric intensive care unit (PICU) patients' parents to interviews on end-of-life decision making for their child.

Methods: We conducted semistructured interviews on end-of-life decision making with PICU patients' parents from two tertiary care PICUs.

Staphylococcus aureus sepsis and the Waterhouse-Friderichsen syndrome in children.

Staphylococcus aureus has increasingly been recognized as a cause of severe invasive illness. We describe three children who died at our institution after rapidly progressive clinical deterioration from this infection, with necrotizing pneumonia and multiple-organ-system involvement. The identification of bilateral adrenal hemorrhage at autopsy was characteristic of the Waterhouse-Friderichsen syndrome, a constellation of findings usually associated with fulminant meningococcemia.

Use of vasopressin in refractory hypotension in children with vasodilatory shock: five cases and a review of the literature.

This article describes case studies of five children treated with vasopressin for refractory hypotension. In addition, physiology and pharmacology of vasopressin are reviewed in a comprehensive survey of the literature from 1966 until the present. In all five children, blood pressure increased immediately after vasopressin administration.