A 1-week-old girl is brought to the emergency department by ambulance due to fever and irritability. She was born at term via precipitous vaginal delivery and had an uncomplicated nursery course. Prenatal laboratory results included a positive group B streptococcal screen, for which the mother received intrapartum antibiotics. The infant's mother and father are both age 16, and the father is not involved in the infant's care. The infant lives with her mother and maternal grandparents in their home. The mother is present in the emergency department along with both of her parents. Temperature is 38.3 C (101 F) and pulse oximetry is 87% on room air. The infant is intermittently apneic and appears cyanotic. Anterior and posterior fontanelles are bulging. Pulmonary examination reveals tachypnea, intercostal retractions, and clear breath sounds bilaterally. The infant's examination is concerning for meningitis and the child requires intubation and mechanical ventilation; however, the mother refuses the procedure. Which of the following is the best next step in management of this patient?

Question

A 1-week-old girl is brought to the emergency department by ambulance due to fever and irritability.  She was born at term via precipitous vaginal delivery and had an uncomplicated nursery course.  Prenatal laboratory results included a positive group B streptococcal screen, for which the mother received intrapartum antibiotics.  The infant's mother and father are both age 16, and the father is not involved in the infant's care.  The infant lives with her mother and maternal grandparents in their home.  The mother is present in the emergency department along with both of her parents.  Temperature is 38.3 C (101 F) and pulse oximetry is 87% on room air.  The infant is intermittently apneic and appears cyanotic.  Anterior and posterior fontanelles are bulging.  Pulmonary examination reveals tachypnea, intercostal retractions, and clear breath sounds bilaterally.  The infant's examination is concerning for meningitis and the child requires intubation and mechanical ventilation; however, the mother refuses the procedure.  Which of the following is the best next step in management of this patient?

Quizplus · Accepted Answer

11ec25c8_d74c_6eda_bc81_bfb100fa7a16_MD0003_00 Informed consent provides patients with information that allows for educated decision-making about their health care. The procedure and its indications, risks, benefits, and alternatives should be clearly described. Informed consent ideally is obtained from the parents of minors prior to performing a procedure. The exception is emergency, life-threatening conditions in which the parent or legal guardian cannot or does not provide consent and delaying treatment would result in harm to the patient. Although this infant's mother is a minor, she can legally consent to medical care for her child. However, parents have the responsibility to make decisions in the best interest of their child and therefore cannot refuse life-saving treatment. This infant requires intubation and mechanical ventilation to live. In situations that are not time-sensitive, the hospital legal counsel and ethics committee should be involved and a court order obtained to overrule the parent's wishes (Choices C and E). However, this patient has an unstable airway requiring emergency treatment; obtaining an ethics consult or legal counsel would delay treatment. The correct course of action is to proceed with treatment regardless of parental consent. Other situations in which obtaining consent should not delay acute care include urgent blood transfusions and emergency surgery. (Choices A and D) Consent is not required in this emergency situation, and attempting to contact the father would only delay life-saving treatment. In addition, grandparents cannot provide consent unless they are the legal guardians. (Choice B) Child protective services should be involved when parents are not acting in the best interest of their child. However, this patient is in critical condition and should first be stabilized. Educational objective: Parents who are themselves minors can give consent to medical care for their child. However, consent is not required in emergency situations, and parents cannot refuse life-saving treatment for their child. References: Consent for emergency medical services for children and adolescents. (http://www.ncbi.nlm.nih.gov/pubmed/12612264) Informed consent for emergency surgery in infants and children. (http://www.ncbi.nlm.nih.gov/pubmed/16080940) Minors' rights in medical decision making. (http://www.ncbi.nlm.nih.gov/pubmed/17728582)

A 1-Week-Old Girl Is Brought to the Emergency Department by Ambulance