Neonatal Deaths: Prospective Exploration Of The Causes And Process Of End-of- Life Decisions.

Title

Neonatal Deaths: Prospective Exploration Of The Causes And Process Of End-of- Life Decisions.

Creator

Hellmann J; Knighton R; Lee SK; Shah P; Andrews W; Payot A

Identifier

DOI: 10.1136/archdischild-2015-308425

Publisher

Archives Of Disease In Childhood

Date

2016

Subject

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

Description

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.

Rights

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).

Citation List Month

March 2016 List

Citation

Hellmann J; Knighton R; Lee SK; Shah P; Andrews W; Payot A, “Neonatal Deaths: Prospective Exploration Of The Causes And Process Of End-of- Life Decisions.,” Pediatric Palliative Care Library, accessed October 17, 2021, https://pedpalascnetlibrary.omeka.net/items/show/10572.

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