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[Withdrawal of treatment in severely ill newborn infants]
1Det medisinske fakultet, Norges teknisk-naturvitenskapelige universitet, Trondheim. linesy@online.no
Insights
In Norwegian neonatal care, withdrawing treatment led to 65% of infant deaths, primarily in premature infants. Parental involvement was common, but decision documentation was poor, necessitating a review of ethical and practical implications.
Area of Science:
- Neonatal Medicine
- Perinatal Care
- Pediatric Critical Care
Context:
- Advances in perinatal medicine improve survival rates for high-risk infants.
- Some survivors face severe complications, impacting quality of life.
- Withdrawing treatment is a common end-of-life decision in neonatal intensive care.
Purpose:
- To analyze the causes of death in neonatal care in Norway.
- To investigate the role of treatment withdrawal in infant mortality.
- To assess parental involvement and record documentation in end-of-life decisions.
Summary:
- A review of 178 infant deaths (1990-1999) in a Norwegian hospital.
- 65% of deaths resulted from treatment withdrawal, predominantly in premature infants (74%).
- Parents were typically involved in decisions, but documentation was inadequate.
Impact:
- Highlights the significant role of treatment withdrawal in neonatal mortality.
- Reveals poor documentation of critical end-of-life decision-making processes.
- Suggests a need to review ethical, legal, and practical aspects of treatment withdrawal in neonatal care.
Background:
Improvements in diagnostics and treatment in perinatal medicine have enabled us to save more premature and critically ill infants and infants born with severe congenital anomalies. However, some of these children often develop complications with a poor prognosis both for survival and quality of life. An active decision to withdraw treatment is common practice in such cases. Little is known about the impact of this problem in neonatal care in Norway.
Material And Methods:
The records of 178 infants admitted as newborns and who died in our hospital during the period 1990-1999 were reviewed and analysed according to these groups: death in spite of full treatment, death because of active withdrawal of treatment, and death after palliative treatment. We also evaluated to what extent the parents were involved in the decision making process and how that process was documented in patient records.
Results:
Death after withdrawal of treatment was identified in 65% of the cases and was mainly seen in critically ill immature and premature infants (74%). The parents were usually involved in the decision, though documentation in patient records of the decision making process was generally poor. The ethical, legal and practical implications of this state of affairs probably need to be reviewed.
