End‐of‐life care over four decades in a quaternary neonatal intensive care unit
- Resource Type
- Authors
- Alexandra Barry; Trisha Prentice; Dominic Wilkinson
- Source
- Journal of Paediatrics and Child Health. 59:341-345
- Subject
- Pediatrics, Perinatology and Child Health
- Language
- ISSN
- 1440-1754
1034-4810
Background: Death in the neonatal intensive care unit commonly follows a decision to withdraw or limit life-sustaining treatment. Advances in medicine has changed the nature of life-sustaining interventions available and the potential prognosis for many newborn conditions. Objective: To assess changes in causes of death and end-of-life care over nearly four decades. Methods: A retrospective review of infants dying in the neonatal intensive care unit was performed (2017-2020) and compared with previous audits performed in the same centre (1985-1987 and 1999-2001). Diagnoses at death were recorded for each infant as well as their apparent prognosis and any withdrawal or limitations of medical treatment. Results: In the recent epoch there were 88 deaths out of 2084 admissions (4.2%), a reduction from the previous epochs (132/1362 (9.7%) and 111/1776 (6.2%) respectively for epochs 1 and 2). More than 90% of infants died after withdrawal of life-sustaining treatment, an increase from the previous two epochs (75%). There was a reduction in deaths from chromosomal abnormalities, complications related to prematurity and severe birth asphyxia. Conclusions: There continue to be considerable changes in both the diagnoses leading to death and approaches to withdrawal of treatment in the neonatal intensive care unit. These may reflect ongoing changes in both prenatal and postnatal diagnostics as well as changing attitudes towards palliative care within the medical and wider community.