End-of-life Decisions For Fragile Neonates: Navigating Between Opinion And Evidence-based Medicine

Title

End-of-life Decisions For Fragile Neonates: Navigating Between Opinion And Evidence-based Medicine

Creator

Janvier A; Farlow B; Verhagen E; Barrington K

Identifier

10.1136/archdischild-2016-311123

Publisher

Archives Of Disease In Childhood. Fetal And Neonatal Edition

Date

2016

Subject

Ethics; Mortality; Neonatology; Palliative Care; Patient Perspective

Description

The majority of neonatal deaths occur after a decision to limit life-sustaining interventions (LSIs). Decisions on when to withhold/withdraw LSIs in fragile neonates are among the most difficult decisions in paediatric practice. Two rigorous investigations shed some light on this topic. Durrmeyer et al systematically described the management of 73 delivery room deaths in the EPIPAGE-2 cohort. The vast majority of neonates had LSI withheld, at a median gestational age of 24 weeks. Pain was usually assessed: 50% of infants received comfort medication, the administration of which was not associated with the evaluation of pain but rather with the presence of gasping. Satisfaction of healthcare providers was strongly associated with the occurrence of parent-child contact, which frequently occurred. Aladangady et al describe the short-term outcome of LSI-limitation discussions with parents in a prospective multicentre trial in the UK (the WILST study). Half of the parents did not agree with providers and opted to continue LSI. When this occurred, it was not rare for the neonates to survive. When parents and providers agreed that LSI should be limited, neonates rarely survived.

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

February 2017 List

Citation

Janvier A; Farlow B; Verhagen E; Barrington K, “End-of-life Decisions For Fragile Neonates: Navigating Between Opinion And Evidence-based Medicine,” Pediatric Palliative Care Library, accessed August 4, 2021, https://pedpalascnetlibrary.omeka.net/items/show/10751.

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