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
Publisher
Archives of Disease in Childhood
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.
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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 April 18, 2024, https://pedpalascnetlibrary.omeka.net/items/show/10751.