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Decision making for seriously compromised newborns: the importance of exploring cultural differences and unintended consequences

Journal of Perinatology volume 33, pages 505–508 (2013)Cite this article

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Baby GC was born to a 23-year-old primagravida mother after a full-term pregnancy complicated at 22 weeks gestation by prenatal diagnosis of fetal anomalies. These anomalies included club feet (talipes equinovalgus), an enlarged cisterna magna, moderate ventriculomegaly with dangling choroid plexus and a head circumference measuring 3 weeks greater than gestational age at 32 weeks. The mother declined further prenatal counseling. At 39 weeks the infant due to breech presentation was delivered by scheduled Cesarean section. Apgars were 4 at 1 min and 8 at 5 min.

The newborn was initially apneic and required positive pressure ventilation. He was stabilized on continuous positive airway pressure and brought to the Newborn Intensive Care Unit. Physical exam confirmed club feet and additionally revealed bilateral dislocated hips, abnormally positioned thumbs, bilateral single palmar creases, stiff fixed joints, low muscle tone with minimal reflexes throughout and bilateral undescended testes. In the first hours of life, bilateral femur fractures were also noted. A Pavlik harness was used to immobilize the legs.

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Authors and Affiliations

  1. Lucile Packard Children’s Hospital, Stanford, CA, USA

    A A Penn

  2. Department of Pediatrics, Stanford Medical School, Stanford, CA, USA

    A A Penn

  3. Department of Bioethics at Boston College, Chestnut Hill, MA, USA

    J J Paris

  4. Department of Bioethics at the Stanford Center for Biomedical Ethics, Stanford, CA, USA

    J J Paris

  5. Boston College Law School, Newton, MA, USA

    M P Moore Jr

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  1. A A Penn
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  2. J J Paris
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Correspondence to J J Paris.

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Penn, A., Paris, J. & Moore, M. Decision making for seriously compromised newborns: the importance of exploring cultural differences and unintended consequences. J Perinatol 33, 505–508 (2013). https://doi.org/10.1038/jp.2012.152

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