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Decision making for the critically ill neonate near the end of life
1Department of Pediatrics, Magee-Womens Hospital, University of Pittsburgh School of Medicine, PA 15213-3180, USA.
Insights
Decisions about limiting life-sustaining treatment for critically ill neonates in the neonatal intensive care unit (NICU) are often made with family involvement. Most deaths were linked to prematurity complications, with treatment limitations chosen in most cases.
Area of Science:
- Neonatal Medicine
- Medical Ethics
- Palliative Care
Background:
- Critically ill neonates face complex end-of-life decisions.
- Neonatal intensive care units (NICUs) manage high-risk infants.
Purpose of the Study:
- To review medical records of deceased infants in a NICU.
- To characterize end-of-life decision-making for critically ill neonates.
Main Methods:
- Retrospective review of 122 infant medical records.
- Analysis of decisions regarding life-sustaining treatment.
Main Results:
- 72% of deaths were due to prematurity complications.
- Families participated in decision-making for 75% of cases.
- 82% of infants had life-sustaining treatment limited, withdrawn, or withheld.
Conclusions:
- Healthcare providers and families collaborate on end-of-life decisions for neonates.
- Limiting, withdrawing, or withholding treatment is common when prognosis is poor or burdens are high.
Abstract:
Our purpose was to review the medical records of 122 infants who died in our neonatal intensive care unit (NICU) to characterize decision making for the critically ill neonate near the end of life. The majority of deaths (72%) were related to some complication of prematurity. Families participated in the decision-making process in 75% of the instances. A decision was made to limit, withdraw, or withhold life-sustaining treatment for 82% of the infants. At the time of decision making, prognosis was judged to be poor or hopeless and the burdens of treatment unacceptable for 90% of the infants. This study confirms that health care providers and families together can confront the ethical decision of whether to continue or forego life-sustaining treatment for the critically ill neonate near the end of life and, in the majority of cases, will choose to limit, withdraw, or withhold such support.