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Information

  1. RESPONSIBILITIES OF THE HEALTH AGENCY
    1. Provide a neonatal intensive care unit (NICU) or transfer to another hospital.
    2. Personnel—adequate number trained in neonate diseases, special treatment, and equipment.
    3. Equipment—adequate supply on hand, functioning properly (especially temperature regulator in incubator, oxygen analyzer, blood-gas machine).
  2. INFANTS WHO ARE DYING
    1. Decision regarding resuscitation in cardiac arrest, with brain damage from cerebral anoxia. It is difficult to predict the effect of anoxia in infancy on the child's later life.
    2. Decision to continue supportive measures.
    3. Issue of euthanasia, such as in severe myelomeningocele at birth.
      1. Active euthanasia (giving overdose).
      2. Passive euthanasia (not placing on respirator).
  3. EXTENDED ROLE OF NURSE IN NICU—may raise issues of nursing practice versus medical practice, as when a nurse draws blood samples for blood gas determinations without prior order. To be legally covered:
    1. The nurse must be trained to perform specialized functions.
    2. The functions must be written into the nurse's job description.
  4. ISSUE OF NEGLIGENCE—such as cross-contamination in nursery.
  5. ISSUE OF MALPRACTICE—such as assigning care of an infant who is critically ill on respirator to a student or aide who is untrained.
    1. May be liable for inaccurate bilirubin studies for neonatal jaundice; may be legally responsible if brain damage occurs in absence of accurate laboratory tests.
    2. May be liable for brain damage in an infant due to respiratory or cardiac distress. Nurse must make sure that there are frequent blood gas determinations to ensure adequate oxygen to prevent brain damage. Nurse also must make sure that the infant is not receiving too high a concentration of oxygen, which may lead to retrolental fibroplasia.