Categorizing Neonatal Deaths: A Cross-Cultural Study in the United States, Canada, and The Netherlands - 07/03/14
, Annie Janvier, MD, PhD b, Steven R. Leuthner, MD c, B. Andrews, MD, MPH d, J. Lagatta, MD d, Arend F. Bos, MD, PhD a, William Meadow, MD, PhD d
Reprint requests: A. A. Eduard Verhagen, Beatrix Children’s Hospital, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.Abstract |
Objective |
To clarify the process of end-of-life decision-making in culturally different neonatal intensive care units (NICUs).
Study design |
Review of medical files of newborns >22 weeks gestation who died in the delivery room (DR) or the NICU during 12 months in 4 NICUs (Chicago, Milwaukee, Montreal, and Groningen). We categorized deaths using a 2-by-2 matrix and determined whether mechanical ventilation was withdrawn/withheld and whether the child was dying despite ventilation or physiologically stable but extubated for neurological prognosis.
Results |
Most unstable patients in all units died in their parents’ arms after mechanical ventilation was withdrawn. In Milwaukee, Montreal, and Groningen, 4% to 12% of patients died while receiving cardiopulmonary resuscitation. This proportion was higher in Chicago (31%). Elective extubation for quality-of-life reasons never occurred in Chicago and occurred in 19% to 35% of deaths in the other units. The proportion of DR deaths in Milwaukee, Montreal, and Groningen was 16% to 22%. No DR deaths occurred in Chicago.
Conclusions |
Death in the NICU occurred differently within and between countries. Distinctive end-of-life decisions can be categorized separately by using a model with uniform definitions of withholding/withdrawing mechanical ventilation correlated with the patient’s physiological condition. Cross-cultural comparison of end-of-life practice is feasible and important when comparing NICU outcomes.
Le texte complet de cet article est disponible en PDF.Mots-clés : CPR, DR, NICU
Plan
| The authors declare no conflicts of interest. |
Vol 156 - N° 1
P. 33-37 - janvier 2010 Retour au numéro
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