Continuation or withdrawal of life-sustaining procedures in newborn infants: a study in 4 centers for neonatal intensive care
De Kleine, M.J.; de Leeuw, R.; Kollée, L.A.; Berger, H.M.
Nederlands Tijdschrift Voor Geneeskunde 137(10): 496-500
1993
ISSN/ISBN: 0028-2162 PMID: 8455740 Document Number: 416021
To provide data about continuation or withdrawal of life sustaining therapy in the critical ill newborn. Retrospective examination of the histories of all 185 patients who died during the year 1990 (17% of total admissions) in 4 out of the 10 neonatal intensive care units in the Netherlands. The mean gestational age was 31.9 weeks (range 23-43; SD 5.5) and the mean birth weight 1827 g (455-5820; SD 1105). 136 infants were prematurely born, 49 full term. Intensive care was not started in 17 (9%) of the 185 patients and intensive care was withdrawn in 58 patients (31%) because there was no chance of survival. Therapy was withdrawn because of the poor prognosis for the quality of later life in 35 patients (19%). Intensive therapy was continued until death occurred in 74 infants (40%). Respiratory and circulatory problems, infections and severe acquired neurological damage were the main causes of death (32%, 17%, 19% and 24% of the cases respectively). In the cases of death due to respiratory and circulatory failure treatment was continued as long as possible. In infants who died with neurological damage as the main diagnosis, treatment was withdrawn because of the poor prognosis for the quality of life in 25 out of 44 infants. Life sustaining therapy was withdrawn or not started in 5% of the patients admitted because there was no chance of survival and in 3% because of a poor prognosis for the quality of later life.