Table 5

Proposed professional framework for communication with parents of babies admitted to neonatal units in the UK

Implied consentExplicit verbal consentExplicit written consent
These interventions can be considered as potentially foreseeable emergency/semiemergency treatments for babies requiring neonatal intensive care. Therefore, where parents are not present, it is reasonable to proceed with the intervention. However, if there is time and the parents are present, it is considered good practice to provide them with the details of the intervention, intended benefits and foreseeable risks.
Documentation of medical care should be recorded in the medical notes using a communication proforma.
Where possible, a discussion should take place with the parents to notify them of the details of the intervention, other options (if thought relevant) and any foreseeable risks and benefits.
Documentation of medical care and the relevant aspects of the discussion with the parents should be recorded in the medical notes using a communication proforma.
Explicit written consent should be obtained alongside explicit verbal information. It should never be considered an entity on its own. A person competent in performing the treatment should take consent using the procedure/alternatives/risks/questions (PARQ) acronym.7
Documentation of medical care and the relevant aspects of the discussion with the parents should be recorded in the medical notes using a communication proforma and the signed consent form filed in the medical notes (a copy should also be provided to the parents).
Peripheral intravenous cannulationLumbar punctureAll surgical operations involving regional or general anaesthetics
Endotracheal intubationScalp vein insertion (cannula or long line)Clinical research studies
Umbilical catheter insertionBlood transfusion (explicit verbal consent on first blood transfusion but would be reasonable to use implied consent thereafter)
Surfactant administrationPharmacological closure of a patent ductus arteriosus with indomethacin, ibuprofen or paracetamol
Intercostal drain insertionDNA CGH array or other specific genetic testing
Therapeutic hypothermiaVentricular tap (for posthaemorrhagic hydrocephalus)
Use of nitric oxide for treatment of term infants with pulmonary hypertensionPeripheral arterial line
Central venous catheter insertion (long line)
Suprapubic aspiration of urine
Use of nitric oxide in preterm infants as trial of therapy
Dilutional exchange transfusion
Double volume exchange transfusion
Use of postnatal steroids to facilitate extubation from ventilator in preterm infants
Urine toxicology to screen for drugs of abuse