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Neonatal end-of-life practice in a German perinatal centre
A Schulz-Baldes1, D Huseman, A Loui
1Institute for Biomedical Ethics, Zurich University Centre for Ethics, Zurich, Switzerland.
Aim:
To investigate the end-of-life practice in a large perinatal centre in Germany.
Methods:
Retrospective chart review was performed in all neonates deceased in the delivery room (n = 31) and the neonatal intensive care unit (n = 47) between 2002 and 2004.
Results:
Neonatal death was preceded by an end-of-life decision (EOLD) in 81% of cases in the delivery room and 83% in the neonatal intensive care unit. The majority of deceased neonates were born prematurely or with congenital malformation. Life-sustaining treatment was not initiated in 74% of the infants deceased in the delivery room. In the unit, 52% died after withdrawal of therapy. Mechanical ventilation was withdrawn most frequently (79% of cases). Futility and immediate death were common considerations in EOLD, but the infant's suffering and future quality of life also played a role. Parents were involved in EOLD-making in all but emergency cases. No active termination of life was performed.
Conclusion:
In our perinatal centre, the majority of neonatal deaths occurred after limitation of therapy. Treatment was actively withdrawn in half of the infants in the neonatal intensive care unit. Actual end-of-life practice in a large perinatal centre differs from the restrictive attitude towards EOLD reported for German neonatologists in previous surveys.
