ReviewFrontiers in pediatrics2020
Moral Distress in the Neonatal Intensive Care Unit: What Is It, Why It Happens, and How We Can Address It.
Review in Frontiers in pediatrics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
43 citing papers in PubMed, 2 syntheses or guidelines pooled it, 105 citations in OpenAlex.
- Ethics and end-of-life in pediatric and neonatal ICUs: a systematic review of recommendations.BMC palliative care · 2025Pooled it
- A rapid review of periviable (22 + 0 to 23 + 6 weeks) counselling practices and the need for a trauma-informed care approach.Frontiers in pediatrics · 2025Pooled it
- Study of the effect of teaching ethical principles using the flipped classroom method on moral distress and moral sensitivity in NICU and PICU nurses.BMC medical ethics · 2026Trial
- Parents Value Shared Decision-Making and Sensitive Communication During End-of-Life Care in Neonatal Intensive Care: An Exploratory Study.Acta paediatrica (Oslo, Norway : 1992) · 2026Observational
- Informed nondissent: an underutilized tool for the NICU context.Journal of perinatology : official journal of the California Perinatal Association · 2026Review
- At the edge of viability: neonatologists' moral experience under uncertainty in Türkiye.BMC medical ethics · 2026Article
- Ethical challenges and moral conflicts in periviability prenatal counseling: a scoping review of healthcare professionals' perspectives.BMC medical ethics · 2026Article
- "The weight of words": a phenomenological study of Chinese neonatologists' lived experiences of delivering bad news.BMC medical ethics · 2026Article
- Lived experiences of healthcare personnel in supporting parents around neonatal death: encounters, challenges and meaning.BMJ paediatrics open · 2026Article
- A tale of two cities: global inequities at the limits of neonatal survival.Pediatric research · 2026Article
- Meaning, Fulfillment, and the Work of Healthcare.Health care analysis : HCA : journal of health philosophy and policy · 2026Article
- Ethical Decision-Making and Clinical Ethics Support in Italian Neonatal Intensive Care Units: Results from a National Survey.Healthcare (Basel, Switzerland) · 2026Article
- Understanding the Influence of the Work Environment on Family-Centered Care Among Nurses in Neonatal Intensive Care Units.Nursing research and practice · 2026Article
- Article
- Experiences and challenges in perinatal palliative care: a qualitative study among parents and healthcare providers in regional and tertiary hospitals.BMC palliative care · 2025Article
- Reducing moral distress through interdisciplinary collaboration: the impact of a weekly palliative care and neonatology conference.BMC palliative care · 2025Article
- Personal characteristics and emotions accompanying nurses and midwives in caring for a newborn with a lethal defect.Scientific reports · 2025Article
- Clinicians' Perceptions About Institutional Factors in Moral Distress Related to Potentially Nonbeneficial Treatments.JAMA network open · 2025Article
- Utility of do-not-resuscitate orders for critically ill infants in the NICU.Pediatric research · 2025Article
- A network analysis of timing and conditions present at time of death for periviable infants (22+0-23+6 weeks) admitted to neonatal intensive care after receiving survival-focused care at birth.Frontiers in pediatrics · 2025Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Moral distress is prevalent in the neonatal intensive care unit (NICU), where decisions regarding end-of-life care, periviable resuscitation, and medical futility are common. Due to its origins in the nursing literature, moral distress has primarily been reported among bedside nurses in relation to the hierarchy of the medical team. However, it is increasingly recognized that moral distress may exist in different forms than initially described and that healthcare professions outside of nursing experience it. Advances in medical technology have allowed the smallest, sickest neonates to survive. The treatment for critically ill infants is no longer simply limited by the capability of medical technology but also by moral and ethical boundaries of what is right for a given child and family. Shared decision-making and the zone of parental discretion can inform and challenge the medical team to balance the complexities of patient autonomy against harm and suffering. Limited ability to prognosticate and uncertainty in outcomes add to the challenges faced with ethical dilemmas. While this does not necessarily equate to moral distress, subjective views of quality of life and personal values in these situations can lead to moral distress if the plans of care and the validity of each path are not fully explored. Differences in opinions and approaches between members of the medical team can strain relationships and affect each individual differently. It is unclear how the various types of moral distress uniquely impact each profession and their role in the distinctively challenging decisions made in the NICU environment. The purpose of this review is to describe moral distress and the situations that give rise to it in the NICU, ways in which various members of the medical team experience it, how it impacts care delivery, and approaches to address it.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.