Withdrawal of Artificial Nutrition and Hydration in Neonatal Critical Care

Artificial nutrition and hydration is defined as the provision of clinically assisted nutrition and fluids via either the enteral or parenteral route, replacing the normal act of eating and drinking. When the prognosis is so bleak and the method of feeding perceived as burdensome and not in a child’s best interest, decisions may be made by the responsible medical team and the parents to withdraw artificial nutrition and hydration in a newborn. While in the past withdrawal of artificial nutrition and hydration (WANH) was a rare occurrence, it is being increasingly considered today, within the overall spectrum of palliative care. The evolving literature based on family experiences demonstrates that it can be a humane practice; however there are important ethical and practical considerations that must be explored in each case. This chapter will: (i) review the historical background of WANH from the neonatal literature, (ii) explore important ethical questions that must be answered before considering WANH, (iii) illustrate the application of WANH in neonatal critical care, and (iv) offer practical considerations for WANH in the neonatal intensive care unit based on parent and professional experiences.