對新生兒加護病房執行DNR困境之建議

Suggestion for the Dilemma of Executing DNR in the Neonatal Intensive Care Unit

近年來兒童在生命末期時選擇不施行心肺復甦術(do-not-resuscitate, DNR)的機率不斷上升，但簽署DNR時間距離死亡過近及簽署比例過低卻是臨床上常見的問題。本篇報告即提出新生兒加護單位在執行DNR時所面臨的困境，其中包括臨床缺乏設置DNR使用指導方針、與家屬溝通上的困難及倫理的考量等等。本文將上述問題經文獻查證後提出臨床建議，希望未來在臨床及學校共同努力下可以改善新生兒在加護病房執行DNR的現況。

The DNR (do-not-resuscitate) order is being increasingly used in pediatric practice. However, all too frequently, the DNR is signed too near the time of death in actual clinical practice. However, even so, the usage of DNR is still deemed inadequate. This article aimed to discuss the dilemma of using DNR in neonatal care. A lack of clear instructions from terminal neonatal patients affects the decision making of physicians. There is also a lack of guidelines for DNR use, which could lead to its lack of completeness. Different cultural and religious backgrounds may affect communication and ethical considerations for neonatal patients. The paper provides some suggestions for the clinical practice of DNR based on a review of the literature. It is hoped that a joint effort between clinical institutions and schools can improve neonatal care quality.