Modes of death in pediatrics: differences in the ethical approach in neonatal and pediatric patients

Area of Science:

• Pediatric critical care medicine
• Neonatal intensive care
• End-of-life care research

Background:

• End-of-life decisions in pediatric intensive care units (PICUs) and neonatal intensive care units (NICUs) require careful consideration.
• Understanding the nuances of death and dying in these distinct patient populations is crucial for improving care.

Purpose of the Study:

• To compare end-of-life decisions and modes of death between neonatal and pediatric patients.
• To identify differences in the circumstances surrounding death in the NICU versus the PICU.

Main Methods:

• Retrospective chart review of all pediatric deaths over a 2-year period at a university hospital.
• Comparison of modes of death, including location (NICU, PICU, other), interventions used, and reasons for death.

Main Results:

• Of 220 deaths, 145 occurred in ICUs (77 NICU, 68 PICU).
• Dying on a respirator was more common in the PICU (51%) than NICU (5%). Unstable physiology was more frequent in the PICU (82% vs. 47%).
• Withdrawal of life-sustaining interventions (LSI) in stable NICU patients for quality of life was common (53% vs. 16% in PICU). Deaths outside ICUs were often due to withholding LSI.

Conclusions:

• Pediatric deaths predominantly occur in ICUs, with distinct patterns in NICU and PICU.
• A notable proportion of NICU deaths involved stable infants where LSI withdrawal may have been a factor.
• Withholding LSI outside ICUs accounted for many deaths, with neonates often succumbing to prematurity and older children to terminal illness.