Treatment choice for infants in the neonatal intensive care unit at risk for AIDS

Article Abstract:

There is an approximate 30 percent chance that a pregnant woman who is infected the human immunodeficiency virus (HIV, which causes AIDS) will infect her unborn child. Many infants who are infected with HIV are also at high risk for premature delivery as well as other conditions that may cause them to be admitted to the neonatal intensive care unit. A survey was conducted in six neonatal intensive care units in New York City regarding the treatment of critically-ill neonates with conditions unrelated to HIV infection. Less aggressive treatment was recommended for infants who were at risk for HIV infection compared with those not at risk. Open heart surgery is one of the conditions that was studied. Ninety-seven percent of the professionals surveyed recommended for open heart surgery for infants with no known risk of HIV infection, while 77 percent recommended surgery for an infant whose mother was infected with HIV, and only 42 percent of the professionals recommended surgery if the infant was known to be infected. At the present time, there is no test for definitively diagnosing HIV infection in newborns. HIV antibodies found in the blood of a newborn may have been produced by the mother and transferred to the infant. Thus some infants may have HIV antibodies in the blood, but may not have HIV infection. Infants who are infected with HIV may die within the first year of life, but others may live for years. Drugs now available can also prolong the life of an child infected with HIV, and infants may live long enough to benefit from a future cure for AIDS. This study showed that treatment for critically ill infants may be altered based whether the child is known to have or suspected of having HIV infection. However, even if antibodies against HIV are present in the blood, the infant may not actually be infected. The treatment of critically-ill infants with and without HIV infection is an ethical issue that must be further examined. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Surveys, Infants (Newborn), Newborn infants, Neonatal intensive care, Terminally ill children, AIDS (Disease) in children, Pediatric AIDS (Disease)

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The HIV-infected surgeon

Article Abstract:

It is estimated that hundreds of practicing surgeons in the US are infected with the human immunodeficiency virus (HIV). In 1989 national attention was paid to the case of a surgeon with acquired immunodeficiency syndrome (AIDS) in Nashville, Tennessee. The details of the case of the surgeon and evaluation of his patients for presence of HIV antibody are discussed in the July 25 issue of The Journal of the American Medical Association. Public anxiety resulted from the media blitz in Tennessee; however, there has been no report of transmission of HIV from a surgeon to a patient. Hospitals must decide upon procedures to follow when a surgeon infected with HIV has performed operations on patients. Public announcement through the media eliminates the issue of confidentiality of the physician infected with HIV, although this is not recommended. Patients operated on by the surgeon should be notified and counselled. Mandatory screening of surgeons is not routinely promoted; however, the American Academy of Orthopedic Surgeons recommends voluntary, confidential testing of health care workers, including orthopedic surgeons. No protocol has been made for positive test results. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, HIV (Viruses), HIV, Disease transmission, Surgeons, Nashville, Tennessee, editorial, Nashville

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The role of the medical profession in physician discipline

Article Abstract:

Medical schools should develop courses in medical ethics that incorporate the principles issued by the American Medical Association's Council on Ethical and Judicial Affairs (CEJA). In a 1997 report, CEJA urged physicians to take a more active role in exposing unethical conduct among their colleagues. A 1998 study found that the percentage of disciplinary actions against physicians that were sex-related doubled between 1989 and 1996. However, this could be due to increased reporting of such offenses rather than an increase in the number of offenses. Nevertheless, the integrity of the profession requires eliminating unethical conduct.

Editorial, Discipline, Physicians, Medical professions, Statistics, Formal discipline

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