1
40
7
-
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
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November 2019 List
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
November 2019 List
URL Address
<a target="_blank" class="vk-MessageLink sc-hxTMRp fGfItZ" href="http://ow.ly/t9Os50wM6GL" rel="noreferrer noopener">http://ow.ly/t9Os50wM6GL</a> <span></span>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Do-Not-Resuscitate Orders in the Neonatal ICU: Experiences and Beliefs Among Staff
Publisher
An entity responsible for making the resource available
Pediatric Critical Care Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2018
Subject
The topic of the resource
Attitude of Health Personnel; Attitudes; Female; Health Knowledge; Hospital/psychology; Humans; Intensive Care Units; Male; Medical Staff; Neonatal/statistics & numerical data; Nursing Staff; Practice; Professional-Family Relations; Resuscitation Orders/psychology; Retrospective Studies; Surveys and Questionnaires; United States; Withholding Treatment/statistics & numerical data
Creator
An entity primarily responsible for making the resource
Arzuaga BH; Wraight CL; Cummings CL; Mao W; Miedema D; Brodsky DD
Description
An account of the resource
OBJECTIVES: Studies in adult patients have shown that do-not-resuscitate orders are often associated with decreased medical intervention. In neonatology, this phenomenon has not been investigated, and how do-not-resuscitate orders potentially affect clinical care is unknown. DESIGN: Retrospective medical record data review and staff survey responses about neonatal ICU do-not-resuscitate orders. SETTING: Four academic neonatal ICUs. SUBJECTS: Clinical staff members working in each neonatal ICU. INTERVENTIONS: Survey response collection and analysis. MEASUREMENTS AND MAIN RESULTS: Participating neonatal ICUs had 14-48 beds and 120-870 admissions/yr. Frequency range of do-not-resuscitate orders was 3-11 per year. Two-hundred fifty-seven surveys were completed (46% response). Fifty-nine percent of respondents were nurses; 20% were physicians. Over the 5-year period, 44% and 17% had discussed a do-not-resuscitate order one to five times and greater than or equal to 6 times, respectively. Fifty-seven percent and 22% had cared for one to five and greater than or equal to 6 patients with do-not-resuscitate orders, respectively. Neonatologists, trainees, and nurse practitioners were more likely to report receiving training in discussing do-not-resuscitate orders or caring for such patients compared with registered nurses and respiratory therapists (p < 0.001). Forty-one percent of respondents reported caring for an infant in whom interventions had been withheld after a do-not-resuscitate order had been placed without discussing the specific withholding with the family. Twenty-seven percent had taken care of an infant in whom interventions had been withdrawn under the same circumstances. Participants with previous experiences withholding or withdrawing interventions were more likely to agree that these actions are appropriate (p < 0.001). CONCLUSIONS: Most neonatal ICU staff report experience with do-not-resuscitate orders; however, many, particularly nurses and respiratory therapists, report no training in this area. Variable beliefs with respect to withholding and withdrawing care for patients with do-not-resuscitate orders exist among staff. Because neonatal ICU patients with do-not-resuscitate orders may ultimately survive, withholding or withdrawing interventions may have long-lasting effects, which may or may not coincide with familial intentions.
Rights
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2018
Arzuaga BH
Attitude Of Health Personnel
Attitudes
Brodsky DD
Cummings CL
Female
Health Knowledge
Hospital/psychology
Humans
Intensive Care Units
Male
Mao W
Medical Staff
Miedema D
Neonatal/statistics & Numerical Data
November 2019 List
Nursing Staff
Pediatric Critical Care Medicine
Practice
Professional-family Relations
Resuscitation Orders/psychology
Retrospective Studies
Surveys And Questionnaires
United States
Withholding Treatment/statistics & Numerical Data
Wraight CL
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1177/0269216313484379" target="_blank" rel="noreferrer">http://doi.org/10.1177/0269216313484379</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Impact of a palliative care initiative on end-of-life care in the general wards: A before-and-after study._
Publisher
An entity responsible for making the resource available
Palliative Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2014
Subject
The topic of the resource
Female; Humans; Male; retrospective studies; Palliative Care; Logistic Models; Aged; Comorbidity; cardiopulmonary resuscitation; Program Evaluation; Social Class; retrospective studies; DNAR; cardiopulmonary resuscitation; Resuscitation Orders; Chronic Disease/therapy; Palliative Care; DNAR Outcomes; Life Support Care/statistics & numerical data; Withholding Treatment/statistics & numerical data; Chronic Disease/epidemiology; Patient Admission/statistics & numerical data; Palliative Care; Hospital Mortality/trends; Advance Care Planning/st [Standards]; Forms and Records Control; Life Support Care/mt [Methods]; Advance Care Planning/standards; Asian; Chronic Disease/ep [Epidemiology]; Chronic Disease/th [Therapy]; Clinical Audit; Do-not-resuscitate orders; Forms and Records Control; general wards; Hospital Mortality/td [Trends]; Life Support Care/methods; Life Support Care/sn [Statistics & Numerical Data]; Patient Admission/statistics & numerical data; Patient Admission/td [Trends]; Patient Admission/trends; Resuscitation Orders; Singapore/ep [Epidemiology]; Singapore/epidemiology; Withholding Treatment/sn [Statistics & Numerical Data]
Creator
An entity primarily responsible for making the resource
Tan A; Seah A; Chua G; Lim Tow K; Phua J
Description
An account of the resource
BACKGROUND: Data on deaths in the general wards of our hospital in 2007 revealed infrequent discussions on end-of-life care and excessive burdensome interventions., AIM: A physician order form to withhold inappropriate life-sustaining interventions was initiated in 2009. The use of the form was facilitated by staff educational sessions and a palliative care consult service. This study aims to evaluate the impact of these interventions in 2010., DESIGN: Retrospective medical chart review with comparisons was made for the following: baseline patient characteristics, orders concerning life-sustaining therapies, treatment provided in last 24 h of life, and discussion of specific life-sustaining therapies with patients and families., SETTINGS/PARTICIPANTS: This study included all adult patients who died in our hospital's general wards in 2007 (N = 683) versus 2010 (N = 714)., RESULTS: There was an increase in orders to withhold life-sustaining therapies, such as cardiopulmonary resuscitation (66.2%-80.0%). There was a decrease in burdensome interventions such as antibiotics (44.9%-24.9%) and a small increase in palliative treatments such as analgesia (29.1%-36.7%). There were more discussions on the role of cardiopulmonary resuscitation with conversant patients (4.6%-10.2%) and families (56.5%-79.8%) (p-value all < 0.05). On multivariate analysis, the physician order form independently predicted orders to withhold cardiopulmonary resuscitation., CONCLUSIONS: A multifaceted intervention of a physician order form, educational sessions, and palliative care consult service led to an improvement in documentation of end-of-life discussions and was associated with an increase in such discussions and less burdensome treatments. There were small improvements in the proportion of palliative treatments administered.
2014
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1177/0269216313484379" target="_blank" rel="noreferrer">10.1177/0269216313484379</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2014
Advance Care Planning/st [Standards]
Advance Care Planning/standards
Aged
Asian
Backlog
Cardiopulmonary Resuscitation
Chronic Disease/ep [Epidemiology]
Chronic Disease/epidemiology
Chronic Disease/th [Therapy]
Chronic Disease/therapy
Chua G
Clinical Audit
Comorbidity
DNAR
DNAR Outcomes
Do-not-resuscitate Orders
Female
Forms and Records Control
general wards
Hospital Mortality/td [Trends]
Hospital Mortality/trends
Humans
Journal Article
Life Support Care/methods
Life Support Care/mt [Methods]
Life Support Care/sn [Statistics & Numerical Data]
Life Support Care/statistics & numerical data
Lim Tow K
Logistic Models
Male
Palliative Care
Palliative Medicine
Patient Admission/statistics & numerical data
Patient Admission/td [Trends]
Patient Admission/trends
Phua J
Program Evaluation
Resuscitation Orders
Retrospective Studies
Seah A
Singapore/ep [Epidemiology]
Singapore/epidemiology
Social Class
Tan A
Withholding Treatment/sn [statistics & Numerical Data]
Withholding Treatment/statistics & Numerical Data
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1016/j.jpeds.2009.07.019" target="_blank" rel="noreferrer">http://doi.org/10.1016/j.jpeds.2009.07.019</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Categorizing neonatal deaths: a cross-cultural study in the United States, Canada, and The Netherlands.
Publisher
An entity responsible for making the resource available
The Journal Of Pediatrics
Date
A point or period of time associated with an event in the lifecycle of the resource
2010
Subject
The topic of the resource
Female; Humans; infant; Male; United States; Intensive Care Units; Terminal Care; Canada; Netherlands; Cross-Cultural Comparison; Respiration; Neonatal; decision making; Newborn; gestational age; Artificial; Withholding Treatment/statistics & numerical data; Physician Assisted Dying PAD; decision making; Diseases/mortality; Diseases/mortality; Withholding Treatment/statistics & numerical data
Creator
An entity primarily responsible for making the resource
Verhagen AAE; Janvier A; Leuthner SR; Andrews B; Lagatta J; Bos AF; Meadow W
Description
An account of the resource
OBJECTIVE: To clarify the process of end-of-life decision-making in culturally different neonatal intensive care units (NICUs). STUDY DESIGN: Review of medical files of newborns >22 weeks gestation who died in the delivery room (DR) or the NICU during 12 months in 4 NICUs (Chicago, Milwaukee, Montreal, and Groningen). We categorized deaths using a 2-by-2 matrix and determined whether mechanical ventilation was withdrawn/withheld and whether the child was dying despite ventilation or physiologically stable but extubated for neurological prognosis. RESULTS: Most unstable patients in all units died in their parents' arms after mechanical ventilation was withdrawn. In Milwaukee, Montreal, and Groningen, 4% to 12% of patients died while receiving cardiopulmonary resuscitation. This proportion was higher in Chicago (31%). Elective extubation for quality-of-life reasons never occurred in Chicago and occurred in 19% to 35% of deaths in the other units. The proportion of DR deaths in Milwaukee, Montreal, and Groningen was 16% to 22%. No DR deaths occurred in Chicago. CONCLUSIONS: Death in the NICU occurred differently within and between countries. Distinctive end-of-life decisions can be categorized separately by using a model with uniform definitions of withholding/withdrawing mechanical ventilation correlated with the patient's physiological condition. Cross-cultural comparison of end-of-life practice is feasible and important when comparing NICU outcomes.
2010-01
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1016/j.jpeds.2009.07.019" target="_blank" rel="noreferrer">10.1016/j.jpeds.2009.07.019</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2010
Andrews B
Artificial
Backlog
Bos AF
Canada
Cross-cultural Comparison
Decision Making
Diseases/mortality
Female
Gestational Age
Humans
Infant
Intensive Care Units
Janvier A
Journal Article
Lagatta J
Leuthner SR
Male
Meadow W
Neonatal
Netherlands
Newborn
Physician Assisted Dying PAD
Respiration
Terminal Care
The Journal Of Pediatrics
United States
Verhagen AAE
Withholding Treatment/statistics & Numerical Data
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1111/j.1440-1754.2008.01353.x" target="_blank" rel="noreferrer">http://doi.org/10.1111/j.1440-1754.2008.01353.x</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Withdrawal and limitation of life-sustaining treatments in a paediatric intensive care unit and review of the literature.
Publisher
An entity responsible for making the resource available
Journal Of Paediatrics And Child Health
Date
A point or period of time associated with an event in the lifecycle of the resource
2008
Subject
The topic of the resource
Child; Humans; Intensive Care Units; New South Wales; Hospital Mortality; Hospitals; adolescent; Preschool; infant; retrospective studies; Withholding Treatment/statistics & numerical data; Terminal Care; Pediatric/statistics & numerical data; Medical Audit; Medical Futility; Physician's Practice Patterns/statistics & numerical data
Creator
An entity primarily responsible for making the resource
Moore P; Kerridge I; Gillis J; Jacobe S; Isaacs D
Description
An account of the resource
OBJECTIVES: To examine withdrawal and limitation of life-sustaining treatment (WLST) in an Australian paediatric intensive care unit (PICU) and to compare this experience with published data from other countries. DESIGN: Retrospective chart review and literature review. SOURCE OF DATA: Review of 12 months of patient records from a tertiary Australian children's teaching hospital. Medline search using relevant key words focusing on death and PICU. RESULTS: Twenty of 27 deaths (74%) followed either WLST (n = 16) or Do Not Resuscitate (DNR) orders (n = 4); five children failed cardiopulmonary resuscitation (CPR); and two children were brain-dead. Meetings between the medical team and family were documented for 15 of 16 children (93.8%) before treatment was withdrawn. The average time between withdrawal of life support and death was 13 min. A review of the English-language literature revealed that 18-65% occurring in PICUs worldwide follow WLST and/or institution of DNR orders. Rates were higher (30-65%) in North America and Europe than elsewhere. Most PICU deaths occurred within 3 days of admission. North American and British parents appear to be involved in decisions regarding withdrawal and limitation of treatment more often than parents in other countries. CONCLUSIONS: Withdrawal and limitation of life-sustaining treatment was more common in an Australian children's hospital ICU than has been reported from other countries. Details of discussion with parents, including the basis for any decision to WLST, were almost always documented in the patient's medical record.
2008-08
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1111/j.1440-1754.2008.01353.x" target="_blank" rel="noreferrer">10.1111/j.1440-1754.2008.01353.x</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2008
Adolescent
Backlog
Child
Gillis J
Hospital Mortality
Hospitals
Humans
Infant
Intensive Care Units
Isaacs D
Jacobe S
Journal Article
Journal of Paediatrics and Child Health
Kerridge I
Medical Audit
Medical Futility
Moore P
New South Wales
Pediatric/statistics & Numerical Data
Physician's Practice Patterns/statistics & numerical data
Preschool
Retrospective Studies
Terminal Care
Withholding Treatment/statistics & Numerical Data
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1016/s0140-6736(05)61028-8" target="_blank" rel="noreferrer">http://doi.org/10.1016/s0140-6736(05)61028-8</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Medical end-of-life decisions in neonates and infants in Flanders
Publisher
An entity responsible for making the resource available
Lancet
Date
A point or period of time associated with an event in the lifecycle of the resource
2005
Subject
The topic of the resource
Euthanasia; Non-U.S. Gov't; PedPal Lit; decision making; Withholding Treatment/statistics & numerical data; 48.9-64.0). Lethal drugs were administered in 15 cases among 117 early neonatal deaths and in two cases among 77 later deaths (13%vs 3%; 70.1-85.5) of the 121 physicians thought that their professional duty sometimes includes the prevention of unnecessary suffering by hastening death and 69 (58%; 95% CI 70.4-82.4) of the 253 deaths studied; Active/psychology/statistics & numerical data Female Humans Infant Infant; and such a decision was made in 14 3 cases (57%; Attitude of Health Personnel Belgium; Newborn Male Pain/therapy Palliative Care/statistics & numerical data Physicians/; p=0.018). The attitude study showed that 95 (79%; psychology Questionnaires Research Support
Creator
An entity primarily responsible for making the resource
Provoost V; Cools F; Mortier F; Bilsen J; Ramet J; Vandenplas Y; Deliens L
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1016/s0140-6736(05)61028-8" target="_blank" rel="noreferrer">10.1016/s0140-6736(05)61028-8</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
Description
An account of the resource
2005
2005
48.9-64.0). Lethal drugs were administered in 15 cases among 117 early neonatal deaths and in two cases among 77 later deaths (13%vs 3%
70.1-85.5) of the 121 physicians thought that their professional duty sometimes includes the prevention of unnecessary suffering by hastening death and 69 (58%
95% CI 70.4-82.4) of the 253 deaths studied
Active/psychology/statistics & numerical data Female Humans Infant Infant
and such a decision was made in 14 3 cases (57%
Attitude of Health Personnel Belgium
Backlog
Bilsen J
Cools F
Decision Making
Deliens L
Euthanasia
Journal Article
Lancet
Mortier F
Newborn Male Pain/therapy Palliative Care/statistics & numerical data Physicians/
Non-U.S. Gov't
p=0.018). The attitude study showed that 95 (79%
PedPal Lit
Provoost V
psychology Questionnaires Research Support
Ramet J
Vandenplas Y
Withholding Treatment/statistics & Numerical Data
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
Backlog
URL Address
<a href="http://doi.org/10.1007/s00134-003-1989-3" target="_blank" rel="noreferrer">http://doi.org/10.1007/s00134-003-1989-3</a>
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Decisions to forgo life-sustaining therapy in ICU patients independently predict hospital death
Publisher
An entity responsible for making the resource available
Intensive Care Medicine
Date
A point or period of time associated with an event in the lifecycle of the resource
2003
Subject
The topic of the resource
Female; Humans; Male; Hospital Mortality; Prospective Studies; Aged; Middle Aged; Comorbidity; Resuscitation Orders; Severity of Illness Index; Survival Analysis; Risk Factors; Hospitals; Analysis of Variance; Predictive Value of Tests; Proportional Hazards Models; Teaching; 80 and over; Empirical Approach; Death and Euthanasia; decision making; ICU Decision Making; Intensive Care Units/statistics & numerical data; APACHE; Critical Care/statistics & numerical data; Life Support Care/statistics & numerical data; Paris/epidemiology; Withholding Treatment/statistics & numerical data
Creator
An entity primarily responsible for making the resource
Azoulay E; Pochard F; Garrouste-Orgeas M; Moreau D; Montesino L; Adrie C; deLassence A; Cohen Y; Timsit JF; Outcomerea Study Group
Description
An account of the resource
OBJECTIVE: More than one-half the deaths of patients admitted to intensive care units (ICUs) occur after a decision to forgo life-sustaining therapy (DFLST). Although DFLSTs typically occur in patients with severe comorbidities and intractable acute medical disorders, other factors may influence the likelihood of DFLSTs. The objectives of this study were to describe the factors and mortality associated with DFLSTs and to evaluate the potential independent impact of DFLSTs on hospital mortality. DESIGN AND SETTING: Prospective multicenter 2-year study in six ICUs in France. PATIENTS: The 1,698 patients admitted to the participating ICUs during the study period, including 295 (17.4%) with DFLSTs. MEASUREMENTS AND RESULTS: The impact of DFLSTs on hospital mortality was evaluated using a model that incorporates changes in daily logistic organ dysfunction scores during the first ICU week. Univariate predictors of death included demographic factors (age, gender), comorbidities, reasons for ICU admission, severity scores at ICU admission, and DFLSTs. In a stepwise Cox model five variables independently predicted mortality: good chronic health status (hazard ratio, 0.479), SAPS II score higher than 39 (2.05), chronic liver disease (1.463), daily logistic organ dysfunction score (1.357 per point), and DFLSTs (1.887). CONCLUSIONS: DFLSTs remain independently associated with death after adjusting on comorbidities and severity at ICU admission and within the first ICU week. This highlights the need for further clarifying the many determinants of DFLSTs and for routinely collecting DFLSTs in studies with survival as the outcome variable of interest.
2003
Identifier
An unambiguous reference to the resource within a given context
<a href="http://doi.org/10.1007/s00134-003-1989-3" target="_blank" rel="noreferrer">10.1007/s00134-003-1989-3</a>
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
The nature or genre of the resource
Journal Article
2003
80 And Over
Adrie C
Aged
Analysis of Variance
APACHE
Azoulay E
Backlog
Cohen Y
Comorbidity
Critical Care/statistics & numerical data
Death and Euthanasia
Decision Making
deLassence A
Empirical Approach
Female
Garrouste-Orgeas M
Hospital Mortality
Hospitals
Humans
ICU Decision Making
Intensive Care Medicine
Intensive Care Units/statistics & numerical data
Journal Article
Life Support Care/statistics & numerical data
Male
Middle Aged
Montesino L
Moreau D
Outcomerea Study Group
Paris/epidemiology
Pochard F
Predictive Value of Tests
Proportional Hazards Models
Prospective Studies
Resuscitation Orders
Risk Factors
Severity Of Illness Index
Survival Analysis
Teaching
Timsit JF
Withholding Treatment/statistics & Numerical Data
-
Text
A resource consisting primarily of words for reading. Examples include books, letters, dissertations, poems, newspapers, articles, archives of mailing lists. Note that facsimiles or images of texts are still of the genre Text.
Citation List Month
March 2016 List
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Neonatal Deaths: Prospective Exploration Of The Causes And Process Of End-of- Life Decisions.
Publisher
An entity responsible for making the resource available
Archives Of Disease In Childhood
Date
A point or period of time associated with an event in the lifecycle of the resource
2016
Subject
The topic of the resource
Asphyxia Neonatorum/mortality; Canada/epidemiology; Cause Of Death; Chromosome Aberrations; Clinical Decision-making; Congenital Abnormalities/mortality; Humans; Hypoxia-ischemia Brain/mortality; Infant Extremely Premature; Infant Newborn; Infant Premature; Intensive Care Units Neonatal; Intracranial Hemorrhages/mortality; Lung Diseases/mortality; Patient Care Team; Practice Patterns Physicians'/statistics & Numerical Data; Prospective Studies; Term Birth; Withholding Treatment/statistics & Numerical Data
Ethics; Mortality; Neonatology; Palliative Care
Creator
An entity primarily responsible for making the resource
Hellmann J; Knighton R; Lee SK; Shah P; Andrews W; Payot A
Description
An account of the resource
OBJECTIVE:
To determine the causes and process of death in neonates in Canada.
DESIGN:
Prospective observational study.
SETTING:
Nineteen tertiary level neonatal units in Canada.
PARTICIPANTS:
942 neonatal deaths (215 full-term and 727 preterm).
EXPOSURE AND OUTCOME:
Explored the causes and process of death using data on: (1) the rates of withdrawal of life-sustaining treatment (WLST); (2) the reasons for raising the issue of WLST; (3) the extent of consensus with parents; (4) the consensual decision-making process both with parents and the multidisciplinary team; (5) the elements of WLST; and (6) the age at death and time between WLST and actual death.
RESULTS:
The main reasons for deaths in preterm infants were extreme immaturity, intraventricular haemorrhage and pulmonary causes; in full-term infants asphyxia, chromosomal anomalies and syndromic malformations. In 84% of deaths there was discussion regarding WLST. WLST was agreed to by parents with relative ease in the majority of cases. Physicians mainly offered WLST for the purpose of avoiding pain and suffering in imminent death or survival with a predicted poor quality of life. Consensus with multidisciplinary team members was relatively easily obtained. There was marked variation between centres in offering WLST for severe neurological injury in preterm (10%-86%) and severe hypoxic-ischaemic encephalopathy in full-term infants (5%-100%).
CONCLUSIONS AND RELEVANCE:
In Canada, the majority of physicians offered WLST to avoid pain and suffering or survival with a poor quality of life. Variation between units in offering WLST for similar diagnoses requires further exploration.
Identifier
An unambiguous reference to the resource within a given context
DOI: 10.1136/archdischild-2015-308425
Rights
Information about rights held in and over the resource
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
2016
Andrews W
Archives of Disease in Childhood
Asphyxia Neonatorum/mortality
Canada/epidemiology
Cause Of Death
Chromosome Aberrations
Clinical Decision-making
Congenital Abnormalities/mortality
Ethics
Hellmann J
Humans
Hypoxia-ischemia Brain/mortality
Infant Extremely Premature
Infant Newborn
Infant Premature
Intensive Care Units Neonatal
Intracranial Hemorrhages/mortality
Knighton R
Lee SK
Lung Diseases/mortality
March 2016 List
Mortality
Neonatology
Palliative Care
Patient Care Team
Payot A
Practice Patterns Physicians'/statistics & Numerical Data
Prospective Studies
Shah P
Term Birth
Withholding Treatment/statistics & Numerical Data