Accredited Nursing Continuing Education

Case Report

A male infant was born at term to a 28-year-old Dominican woman; an emergency cesarean section was performed because of placental abruption. After the delivery, full resuscitative measures were performed. The patient had no heart rate until 25 minutes of life, after administration of multiple doses of epinephrine, intubation, and bilateral chest tube placement for pneumothoraces. The patient was transferred to the neonatal intensive care unit.

When the patient was 2 weeks old, his care was taken over by a Spanish-speaking resident. The patient's problem list at that point was extensive. He had sustained severe hypoxic-ischemic encephalopathy, and on physical examination, demonstrated pupils that were poorly reactive to light, decerebrate posturing, and flaccid tone. He was dependent on mechanical ventilation, and an extubation trial had failed. Blood cultures had just grown Flavimonas species. He had anemia, seizures, and was recovering from acute renal failure.

When the resident first met the family, they knew little about their baby's prognosis. The staff had reported thorough interpreter-assisted communication. However, the family believed that their baby would soon recover and be released. The staff claimed that the family was in denial, when in fact they had no idea of the neurologic devastation the infant had sustained.

The next weeks in the NICU were quite difficult for the family because of having to deal with the reality of the new prognosis. Multiple meetings were arranged to discuss the code status (after repeated extubation failures), a tracheostomy, and gastrostomy tube placement.

-- Journal of Pediatrics
Used with permission.