Experience with newborn intensive care deaths in a tertiary setting

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Medical Ethics

Background:

• Neonatal intensive care units (NICUs) provide critical care for premature and ill newborns.
• End-of-life care decisions in NICUs involve complex ethical and medical considerations.
• Understanding trends in infant mortality within NICUs is crucial for improving care.

Purpose of the Study:

• To analyze longitudinal trends in infant deaths within a US NICU.
• To compare demographic factors, age at death, and end-of-life care practices between two distinct time periods.
• To identify changes in the utilization of cardiopulmonary resuscitation, do not resuscitate (DNR) status, and withdrawal of support.

Main Methods:

• Retrospective analysis of infant deaths in a US NICU.
• Comparison of two epochs: 1985-1988 (Epoch 1) and 1991-1994 (Epoch 2).
• Data collected included demographics, age at death, cardiopulmonary resuscitation (CPR) use, DNR status, and withdrawal of support.

Main Results:

• Infants in Epoch 2 were younger at birth and at death compared to Epoch 1 (p=0.02).
• Cardiopulmonary resuscitation (CPR) use increased in Epoch 2 (60% vs. 41%, p=0.008).
• Do not resuscitate (DNR) status (80% vs. 59%, p=0.002) and withdrawal of support (72% vs. 52%, p=0.005) were more frequent in Epoch 2.

Conclusions:

• NICU deaths are increasingly occurring at younger gestational ages and post-natal ages.
• End-of-life care in NICUs predominantly involves DNR status and/or withdrawal of support.
• These findings reflect evolving practices in neonatal palliative and end-of-life care.