Rationing potentially inappropriate treatment in newborn intensive care in developed countries

In newborn intensive care, parents sometimes request treatment that professionals regard as 'futile' or 'potentially inappropriate'. One reason not to provide potentially inappropriate treatment is because it would be excessively costly relative to its benefit. Some public health systems around the world assess the cost-effectiveness of treatments and selectively fund those treatments that fall within a set threshold. This article explores the application of such thresholds to questions in newborn intensive care: (i) when a newborn infant's chance of survival is too small; (ii) how long treatment should continue; (iii) when quality of life is too low; and (iv) when newborn infants are too premature for cost-effective intensive care. This analysis yields some potentially surprising conclusions. Newborn intensive care may be cost-effective even in the setting of very low probability of survival, very poor predicted quality of life, for protracted periods of time, or for the most premature of newborns.