Categorizing neonatal deaths: a cross-cultural study in the United States, Canada, and The Netherlands.

Title

Categorizing neonatal deaths: a cross-cultural study in the United States, Canada, and The Netherlands.

Creator

Verhagen AAE; Janvier A; Leuthner SR; Andrews B; Lagatta J; Bos AF; Meadow W

Publisher

The Journal Of Pediatrics

Date

2010

Subject

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

Description

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 We categorized deaths using a 2-by-2 matrix and determined whether mechanical ventilation was withdrawn/withheld and whether the child was dying despite ventilation or physiologically stable but extubated for neurological prognosis. RESULTS: Most unstable patients in all units died in their parents' arms after mechanical ventilation was withdrawn.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

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).

Type

Journal Article

Citation List Month

Backlog

Pages

33-37

Issue

1

Volume

156

Citation

Verhagen AAE; Janvier A; Leuthner SR; Andrews B; Lagatta J; Bos AF; Meadow W, “Categorizing neonatal deaths: a cross-cultural study in the United States, Canada, and The Netherlands.,” Pediatric Palliative Care Library, accessed September 21, 2021, https://pedpalascnetlibrary.omeka.net/items/show/14369.

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