End-of-life decisions in Dutch neonatal intensive care units.

Full Abstract

OBJECTIVE: To clarify the practice of end-of-life decision making in severely ill newborns. DESIGN: Retrospective descriptive study with face-to-face interviews. SETTING: The 10 neonatal intensive care units in the Netherlands from October 2005 to September 2006. PATIENTS: All 367 newborn infants who died in the first 2 months of life in Dutch neonatal intensive care units. Adequate documentation was available in 359 deaths. OUTCOME MEASURES: Presence of end-of-life decisions, classification of deaths in 3 groups, and physicians' considerations leading to end-of-life decisions. RESULTS: An end-of-life decision preceded death in 95% of cases, and in 5% treatment was continued until death. Of all of the deaths, 58% were classified as having no chance of survival and 42% were stabilized newborns with poor prognoses. Withdrawal of life-sustaining therapy was the main mode of death in both groups. One case of deliberate ending of life was found. In 92% of newborns with poor prognoses, end-of-life decisions were based on patients' future quality of life and mainly concerned future suffering. Considerations regarding the infant's present state were made in 44% of infants. CONCLUSIONS: Virtually all deaths in Dutch neonatal intensive care units are preceded by the decision to withdraw life-sustaining treatment and many decisions are based on future quality of life. The decision to deliberately end the life of a newborn may occur less frequently than was previously assumed.

Author information

Author/s: Verhagen, A A Eduard (AA); Dorscheidt, Jozef H H M (JH); Engels, Bernadette (B); Hubben, Joep H (JH); Sauer, Pieter J (PJ);

Affiliation: Department of Pediatrics, University Medical Centre, 9700 RB Groningen, the Netherlands. e.verhagen(-atsign-)bkk.umcg.nl

Journal and publication information

Publication Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't

Journal: Archives of pediatrics & adolescent medicine (Arch Pediatr Adolesc Med), published in United States. (Language: eng)

Reference: 2009-Oct; vol 163 (issue 10) : pp 895-901

Dates: Created 2009/10/06; Completed 2009/10/26;

PMID: 19805707, status: MEDLINE (last retrieval date: 10/26/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Arch Pediatr Adolesc Med. 2009 Oct;163(10):958-9. (PMID: 19805718)

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