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Resuscitation decisions in fetal myelomeningocele repair should center on parents’ values: a counter analysis

Journal of Perinatology volume 42, pages 971–975 (2022)Cite this article

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Abstract

In our response to, “Parental request for non-resuscitation in fetal myelomeningocele repair: an analysis of the novel ethical tensions in fetal intervention” by Wolfe and co-authors, we argue that parental authority should guide resuscitation decision-making for a fetus at risk for preterm delivery as a complication of fetal myelomeningocele (fMMC) repair. Due to the elevated morbidity and mortality risks of combined myelomeningocele, extreme prematurity, and fetal hypoxia, parents’ values regarding the acceptability of possible outcomes should be elicited and their preferences honored. Ethical decision-making in these situations must also consider the broader context of the fetal-maternal dyad. Innovations in fetoscopic approaches to fMMC repair may pose additional complexity to these resuscitation decisions.

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Fig. 1: Ethical approach to determining thresholds for offering versus obligating therapeutic interventions.

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Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Michigan Medicine, Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA

    Stephanie K. Kukora

  2. Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA

    Stephanie K. Kukora

  3. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Jessica T. Fry

  4. Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Jessica T. Fry

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  1. Stephanie K. Kukora
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Contributions

SKK conceptualized the manuscript, co-wrote the initial draft, and revised the manuscript. JTF made substantial contributions to conceptualizing the manuscript, co-wrote the initial draft, and revised the manuscript.

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Correspondence to Stephanie K. Kukora.

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The authors declare no competing interests.

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Kukora, S.K., Fry, J.T. Resuscitation decisions in fetal myelomeningocele repair should center on parents’ values: a counter analysis. J Perinatol 42, 971–975 (2022). https://doi.org/10.1038/s41372-022-01385-7

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  • DOI: https://doi.org/10.1038/s41372-022-01385-7

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