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Cain MR, de Waal K. Mortality in the neonatal intensive care setting: Do benchmarks tell the whole story? J Paediatr Child Health 2024; 60:107-112. [PMID: 38605553 DOI: 10.1111/jpc.16542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 02/26/2024] [Accepted: 03/29/2024] [Indexed: 04/13/2024]
Abstract
AIM Australian neonatal mortality data are collected and shared within collaborative networks. Individual unit outcomes are benchmarked between units and presented in quarterly or yearly reports. Low mortality is commonly interpreted as optimal performance. However, current collected data do not differentiate between death due to severe illness and death following treatment limitation. This study aims to explore the physiological condition immediately before death, and the proportion of deaths attributed to treatment limitation. METHODS This retrospective single centre study of 100 consecutive deaths classified the physiological condition 12 h prior to death as stable or unstable using a clinical illness score based upon pH, oxygen saturation index, medications and blood product use. Documented discussions regarding expected outcomes and goals of management were reviewed for agreed upon treatment limitations and analysed against physiological stability. RESULTS Causes of death were sepsis (n = 24), congenital anomalies (n = 20), extreme prematurity (n = 19), hypoxic ischaemic encephalopathy (n = 18), intraventricular haemorrhage (n = 11) and other (n = 8). Forty-eight infants were physiologically stable at 12 h before death. In infants classified as physiologically stable, 90% of deaths were in a scenario where palliative care was discussed and intensive care treatment was ceased. These deaths accounted for 43% of total mortality in our unit. CONCLUSION A large portion of mortality in our unit could be attributed to treatment limitations in physiologically stable infants with high risk of neurodevelopmental impairment. Our study emphasises the need to consider the physiological status around time of death for optimal benchmarking of mortality between neonatal units.
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Affiliation(s)
- Madeleine-Rose Cain
- Neonatal Intensive Care Unit, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Koert de Waal
- Neonatal Intensive Care Unit, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
- University of Newcastle, Newcastle, New South Wales, Australia
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2
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Ng PC, Fung GPG. Spiritual and cultural influences on end-of-life care and decision-making in NICU. Semin Fetal Neonatal Med 2023; 28:101437. [PMID: 37105859 DOI: 10.1016/j.siny.2023.101437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Understanding and respecting the spiritual beliefs, ethnic roots, cultural norms and customs of individual families is essential for neonatologists to provide clinically appropriate and humane end-of-life care. This review describes the religious/philosophical principles, cultural-related practices/rituals, and traditions in end-of-life care in major spiritual groups of today's multi-cultural, multi-faith societies. The spiritual groups include Christians, Muslims, Jewish Judaism believers and Asian religious/philosophy followers such as Buddhists, Hindus, Taoists, Confucianism devotees and ancestral worshippers. It is vital to understand that substantial variation in views and practices may exist even within the same religion and culture in different geographic locations. Ethical views and cultural practices are not static elements in life but behave in a fluidic and dynamic manner that could change with time. Interestingly, an evolving pattern has been observed in some Asian and Middle East countries that more parents and/or religious groups are beginning to accept a form of redirection of care most compatible with their spiritual belief and culture. Thus, every family must be assessed and counseled individually for end-of-life decision-making. Also, every effort should be made to comply with parents' requests and to treat infants/parents of different religions and cultures with utmost dignity so that they have no regret for their irreversible decisions.
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Affiliation(s)
- Pak C Ng
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
| | - Genevieve P G Fung
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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3
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Dong XY, Zhang WW, Han JM, Bi D, Yang ZY, Wang XL, Wang H, Yang DJ, Zhang CL, Gao R, Zhang BJ, Hu LL, Reddy S, Yuan SK, Yu YH. Determining resuscitation threshold for extremely preterm infants based on the survival rates without severe neurological injury. J Glob Health 2023; 13:04059. [PMID: 37227033 PMCID: PMC10210526 DOI: 10.7189/jogh.13.04059] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
Background Published guidelines on decision-making and resuscitation of extremely preterm infants primarily focus on high-income countries. For rapidly industrializing ones like China, there is a lack of population-based data for informing prenatal management and practice guidelines. Methods The Sino-northern Neonatal Network conducted a prospective multi-centre cohort study between 1 January 2018 and 31 December 2021. Infants with a gestational age (GA) between 22 (postnatal age in days = 0) and 28 (postnatal age in days = 6) admitted to 40 tertiary NICUs in northern China were included and evaluated for death or severe neurological injury before discharge. Results For all extremely preterm infants (n = 5838), the proportion of admission to the neonatal was 4.1% at 22-24 weeks, 27.2% at 25-26 weeks, and 75.2% at 27 and 28 weeks. Among 2228 infants admitted to the NICU, 216 (11.1%) were still elected for withdrawal of care (WIC) due to non-medical factors. Survival rates without severe neurological injury were 6.7% for infants at 22-23 weeks, 28.0% at 24 weeks, 56.7% at 24 weeks, 61.7% at 25 weeks, 79.9% at 26 weeks, and 84.5% at 27 and 28 weeks. Compared with traditional criterion at 28 weeks, the relative risk for death or severe neurological injury were 1.53 (95% confidence interval (CI) = 1.26-1.86) at 27 weeks, 2.32 (95% CI = 1.73-3.11) at 26 weeks, 3.62 (95% CI = 2.43-5.40) at 25 weeks, and 8.91 (95% CI = 4.69-16.96) at 24 weeks. The NICUs with higher proportion of WIC also had a higher rate of death or severe neurological injury after maximal intensive care (MIC). Conclusions Compared to the traditional threshold of 28 weeks, more infants received MIC after 25 weeks, leading to significant increases in survival rates without severe neurological injury. Therefore, the resuscitation threshold should be gradually adjusted from 28 to 25 weeks based on reliable capacity. Registration China Clinical Trials Registry. ID: ChiCTR1900025234.
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Affiliation(s)
- Xiao-Yu Dong
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, China
| | - Wen-Wen Zhang
- Department of Paediatrics, Jinan Maternal and Child Health Hospital, Jinan, China
| | - Jun-Ming Han
- Department of Paediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Dan Bi
- Department of Paediatrics, Qilu Hospital Affiliated to Shandong University, Jinan, China
| | - Zhen-Ying Yang
- Department of Paediatrics, Taian Maternal and Child health Care Hospital, Taian, China
| | - Xiao-Liang Wang
- Department of Paediatrics, Yantai Yuhuangding Hospital, Yantai, China
| | - Hui Wang
- Department of Paediatrics, Hebei PetroChina Central Hospital, Langfang, China
| | - De-Juan Yang
- Department of Paediatrics, The First Affiliated Hospital of Shandong First Medical University, Jinan China
| | - Chun-Lei Zhang
- Department of Paediatrics, Wei Fang Maternal and Child Health Hospital, Weifang, China
| | - Rui Gao
- Department of Paediatrics, Liaocheng People's Hospital, Liaocheng, China
| | - Bing-Jin Zhang
- Department of Paediatrics, Shengli Oilfield Central Hospital, Dongying, China
| | - Li-Li Hu
- Department of Paediatrics, Baogang Third Hospital of Hongci Group, Baotou, China
| | - Simmy Reddy
- Department of Paediatrics, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Sen-Kang Yuan
- Inspur Electronic Information Industry Co. Ltd, China
| | - Yong-Hui Yu
- Department of Paediatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
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4
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Aoki H, Shibasaki J, Tsuda K, Yamamoto K, Takeuchi A, Sugiyama Y, Isayama T, Mukai T, Ioroi T, Yutaka N, Takahashi A, Tokuhisa T, Nabetani M, Iwata O. Predictive value of the Thompson score for short-term adverse outcomes in neonatal encephalopathy. Pediatr Res 2023; 93:1057-1063. [PMID: 35908094 DOI: 10.1038/s41390-022-02212-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 06/30/2022] [Accepted: 07/12/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND To explore the predictive value of the Thompson score during the first 4 days of life for estimating short-term adverse outcomes in neonatal encephalopathy. METHODS This observational study evaluated infants with neonatal encephalopathy (≥36 weeks of gestation) registered in a multicenter cohort of cooled infants in Japan. The Thompson score was evaluated at 0-24, 24-48, 48-72, and 72-90 h of age. Adverse outcomes included death, survival with respiratory impairment (requiring tracheostomy), or survival with feeding impairment (requiring gavage feeding) at discharge. RESULTS Of the 632 infants, 21 (3.3%) died, 59 (9.3%) survived with respiratory impairment, and 113 (17.9%) survived with feeding impairment. The Thompson score throughout the first 4 days accurately predicted death, respiratory impairment, or feeding impairment. The 72-90 h score showed the highest accuracy. A cutoff of ≥15 had a sensitivity of 0.85 and specificity of 0.92 for death or respiratory impairment, while a cutoff of ≥14 had a sensitivity of 0.71 and a specificity of 0.92 for death, respiratory or feeding impairment. CONCLUSION A high Thompson score during the first 4 days of life, especially at 72-90 h could thus be useful for estimating the need for prolonged life support. IMPACT The Thompson score on days 1-4 of age was useful in predicting death and respiratory or feeding impairments. The 72-90 h Thompson score showed the highest predictive capability. Owing to the rarity of withdrawal of life-sustaining treatment in Japan, 43% of infants with persistent severe encephalopathy with a Thompson score of ≥15 at 72-90 h of age could regain spontaneous breathing, be extubated, and survive without tracheostomy. Meanwhile, approximately 50% of infants who survived without tracheostomy required gavage feeding. Our results could provide useful information for clinical decision making regarding infants with persistent severe encephalopathy.
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Affiliation(s)
- Hirosato Aoki
- Department of Neonatology, Kanagawa Children's Medical Center, Kanagawa, Japan
| | - Jun Shibasaki
- Department of Neonatology, Kanagawa Children's Medical Center, Kanagawa, Japan.
| | - Kennosuke Tsuda
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Kouji Yamamoto
- Department of Biostatistics, School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Akihito Takeuchi
- Division of Neonatology, National Hospital Organization Okayama Medical Center, Okayama, Japan
| | - Yuichiro Sugiyama
- Department of Pediatrics, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Aichi, Japan
| | - Tetsuya Isayama
- Division of Neonatology, Center for Maternal-Fetal Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Takeo Mukai
- Center for Advanced Medical Research, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Tomoaki Ioroi
- Department of Pediatrics, Perinatal Medical Center, Himeji Red Cross Hospital, Hyogo, Japan
| | - Nanae Yutaka
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Akihito Takahashi
- Department of Pediatrics, Kurashiki Central Hospital, Okayama, Japan
| | - Takuya Tokuhisa
- Department of Neonatology, Perinatal Medical Center, Imakiire General Hospital, Kagoshima, Japan
| | - Makoto Nabetani
- Department of Pediatrics, Yodogawa Christian Hospital, Osaka, Japan
| | - Osuke Iwata
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
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Barry A, Prentice T, Wilkinson D. End-of-life care over four decades in a quaternary neonatal intensive care unit. J Paediatr Child Health 2023; 59:341-345. [PMID: 36495233 PMCID: PMC10107744 DOI: 10.1111/jpc.16296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022]
Abstract
AIM Death in the neonatal intensive care unit (NICU) commonly follows a decision to withdraw or limit life-sustaining treatment. Advances in medicine have changed the nature of life-sustaining interventions available and the potential prognosis for many newborn conditions. We aimed 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 NICU 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 changes in both the diagnoses leading to death and approaches to withdrawal of treatment in the NICU. These may reflect ongoing changes in both prenatal and post-natal diagnostics as well as changing attitudes towards palliative care within the medical and wider community.
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Affiliation(s)
- Alexandra Barry
- Neonatal Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Trisha Prentice
- Neonatal Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Dominic Wilkinson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy, University of Oxford, Oxford, United Kingdom.,Newborn Care, John Radcliffe Hospital, Oxford, United Kingdom
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6
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Bi SY, Yu YH, Li C, Xu P, Xu HY, Li JH, Liu QY, Li M, Liu XJ, Wang H. A standardized implementation of multicenter quality improvement program of very low birth weight newborns could significantly reduce admission hypothermia and improve outcomes. BMC Pediatr 2022; 22:281. [PMID: 35568937 PMCID: PMC9107002 DOI: 10.1186/s12887-022-03310-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 04/27/2022] [Indexed: 11/12/2022] Open
Abstract
Background Admission hypothermia (AH, < 36.5℃) remains a major challenge for global neonatal survival, especially in developing countries. Baseline research shows nearly 89.3% of very low birth weight (VLBW, < 1500 g) infants suffer from AH in China. Therefore, a prospective multicentric quality improvement (QI) initiative to reduce regional AH and improve outcomes among VLBW neonates was implemented. Methods The study used a sequential Plan—Do—Study—Act (PDSA) approach. Clinical data were collected prospectively from 5 NICUs within the Sino-Northern Neonatal Network (SNN) in China. The hypothermia prevention bundle came into practice on January 1, 2019. The clinical characteristics and outcomes data in the pre-QI phase (January 1, 2018– December 31, 2018) were compared with that from the post-QI phase (January 1, 2019–December 31, 2020). Clinical characteristics and outcomes data were analyzed. Results A total of 750 in-born VLBW infants were enrolled in the study, 270 in the pre-QI period and 480 in the post- QI period, respectively. There were no significant differences in clinical characteristics of infants between these two phases. Compared with pre-QI period, the incidence of AH was decreased significantly after the QI initiative implementation in the post-QI period (95.9% vs. 71.3%, P < 0.01). Incidence of admission moderate-to-severe hypothermia (AMSH, < 36℃) also decreased significantly, manifesting a reduction to 38.5% in the post-QI (68.5% vs 30%, P < 0.01). Average admission temperature improved from after QI (35.5 \documentclass[12pt]{minimal}
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\begin{document}$$\pm$$\end{document}± 0.6℃, P < 0.01). There was no increase in proportion the number of infants with a temperature of > 37.5 °C or thermal burns between the two groups. The risk ratio of mortality in infants during the post-QI period was significantly lower in the post-QI period as compared to the pre-QI period [adjusted risk ratio (aRR): 0.26, 95% confidence interval (CI): 0.13–0.50]. The risk ratio of late-onset neonatal sepsis (LOS) also significantly lowered in the post-QI period (aRR: 0.66, 95% CI: 0.50–0.87). Conclusion Implementation of multicentric thermoregulatory QI resulted in a significant reduction in AH and AMSH in VLBW neonates with associated reduction in mortality. We gained a lot from the QI, and successfully aroused the attention of perinatal medical staff to neonatal AH. This provided a premise for continuous quality improvement of AH in the future, and might provide a reference for implementation of similar interventions in developing countries. Trial registration Trial registration number: ChiCTR1900020861. Date of registration: 21 January 2019(21/01/2019). Prospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03310-5.
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Affiliation(s)
- Shu-Yu Bi
- Department of Neonatology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China
| | - Yong-Hui Yu
- Department of Neonatology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250021, Shandong, China. .,Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
| | - Cong Li
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, China
| | - Ping Xu
- Department of Neonatology, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, China
| | - Hai-Yan Xu
- Department of Neonatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250014, Shandong, China
| | - Jia-Hui Li
- Department of Neonatology, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250014, Shandong, China
| | - Qiong-Yu Liu
- Department of Neonatology, Women and Children's Healthcare Hospital of Linyi, Linyi, 276000, Shandong, China
| | - Min Li
- Department of Neonatology, Women and Children's Healthcare Hospital of Linyi, Linyi, 276000, Shandong, China
| | - Xin-Jian Liu
- Department of Neonatology, Hebei Petro China Central Hospital, Langfang, 065000, Hebei, China
| | - Hui Wang
- Department of Neonatology, Hebei Petro China Central Hospital, Langfang, 065000, Hebei, China
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7
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Lin M, Deming R, Wolfe J, Cummings C. Infant mode of death in the neonatal intensive care unit: A systematic scoping review. J Perinatol 2022; 42:551-568. [PMID: 35058594 DOI: 10.1038/s41372-022-01319-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/21/2021] [Accepted: 01/12/2022] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To characterize literature that describes infant mode of death and to clarify how limitation of life-sustaining treatment (LST) is defined and rationalized. STUDY DESIGN Eligible studies were peer-reviewed, English-language, and included number of infant deaths by mode out of all infant deaths in the NICU and/or delivery room. RESULT 58 included studies were primarily published in the last two decades from North American and European centers. There was variation in rates of infant mode of death by study, with some showing an increase in deaths following limitation of LST over time. Limitation of LST was defined by the intervention withheld/withdrawn, the relationship between the two practices, and prior frameworks. Themes for limiting LST included diagnoses, low predicted survival and/or quality of life, futility, and suffering. CONCLUSION Limitation of LST is a common infant mode of death, although rates, study definitions, and clinical rationale for this practice are variable.
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Affiliation(s)
- Matthew Lin
- Boston Children's Hospital, Division of Newborn Medicine, Boston, MA, USA.
| | - Rachel Deming
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care and Department of Pediatrics, Boston Children's Hospital, Boston, USA
| | - Joanne Wolfe
- Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care and Department of Pediatrics, Boston Children's Hospital, Boston, USA
| | - Christy Cummings
- Boston Children's Hospital, Division of Newborn Medicine, Boston, MA, USA
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8
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Abstract
This article explores the ethical concept of "the equivalence thesis" (ET), or the idea that withdrawing and withholding life sustaining treatments are morally equivalent practices, within neonatology. We review the historical origins, theory, and clinical rationale behind ET, and provide an analysis of how ET relates to literature that describes neonatal mode of death and healthcare professional and parent attitudes towards end-of-life care. While ET may serve as an ethical tool to optimize resource allocation in theory, its clinical utility is limited given the complexity of end-of-life care decisions.
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Affiliation(s)
- Matthew Lin
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA.
| | | | - Christy L Cummings
- Division of Newborn Medicine, Boston Children's Hospital, Boston, MA, USA; Center for Bioethics, Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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9
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Wang L, Zhao LL, Xu JJ, Yu YH, Li ZL, Zhang FJ, Wen HM, Wu HH, Deng LP, Yang HY, Li L, Ding LL, Wang XK, Zhang CY, Wang H. Association between pulmonary hemorrhage and CPAP failure in very preterm infants. Front Pediatr 2022; 10:938431. [PMID: 36160772 PMCID: PMC9500376 DOI: 10.3389/fped.2022.938431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/21/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pulmonary hemorrhage (PH) in neonates is a life-threatening respiratory complication. We aimed to analyze the perinatal risk factors and morbidity with PH among very preterm infants in a large multicenter study. METHODS This was a multicenter case-control study based on a prospective cohort. Participants included 3,680 in-born infants with a gestational age at 24-32 weeks (birth weight <1,500 g) who were admitted between January 1, 2019, and October 31, 2021. All infants were divided into two groups, namely, the PH and no-PH groups, at a ratio of 1:2 according to the following factors: gestational age (GA), birth weight (BW), and the Score for Neonatal Acute Physiology with Perinatal extension II (SNAPPE II). Perinatal factors and outcomes were compared between the two groups by logistic regression analyses. RESULTS A total of 3,680 infants were included in the study, and the number of identified cases of PH was 262 (7.1%). The incidence was 16.9% (136/806) for neonates with extremely low BW (BW < 1,000 g) infants. The multivariate analysis showed that CPAP failure (OR 2.83, 95% CI 1.57, 5.08) was significantly associated with PH. PH was associated with a high likelihood of death (OR 3.81, 95% CI 2.67, 5.43) and bronchopulmonary dysplasia (BPD) (≥grade II) (OR 1.58, 95% CI 1.00, 2.48). CONCLUSIONS In this multicenter case-control study based on a prospective cohort, PH to be common among VLBW infants. PH is associated with significant morbidity and mortality, and perinatal management, especially CPAP failure. Respiratory management strategies to decrease the risk of PH should be optimized.
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Affiliation(s)
- Li Wang
- The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Li-Li Zhao
- Liaocheng People's Hospital, Liaocheng, China
| | - Jia-Ju Xu
- Yantai Yuhuangding Hospital, Yantai, China
| | - Yong-Hui Yu
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | | | - Feng-Juan Zhang
- The First Affiliated Hospital of Shandong First Medical University, Jinan, China
| | - Hui-Min Wen
- Hebei PetroChina Central Hospital, Langfang, China
| | - Hai-Huan Wu
- Baogang Third Hospital of Hongci Group, Baotou, China
| | | | - Hui-Yu Yang
- Women and Children's Healthcare Hospital of Linyi, Linyi, China
| | - Li Li
- Linyi People's Hospital, Linyi, China
| | - Lan-Lan Ding
- Jinan Maternity and Child Health Care Hospital, Jinan, China
| | - Xiao-Kang Wang
- Central Hospital of Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | | | - Hui Wang
- Hebei PetroChina Central Hospital, Langfang, China
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10
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Zhang WW, Yu YH, Dong XY, Reddy S. Treatment status of extremely premature infants with gestational age < 28 weeks in a Chinese perinatal center from 2010 to 2019. World J Pediatr 2022; 18:67-74. [PMID: 34767193 PMCID: PMC8761149 DOI: 10.1007/s12519-021-00481-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/28/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND There is a paucity of studies conducted in China on the outcomes of all live-birth extremely premature infants (EPIs) and there is no unified recommendation on the active treatment of the minimum gestational age in the field of perinatal medicine in China. We aimed to investigate the current treatment situation of EPIs and to provide evidence for formulating reasonable treatment recommendations. METHODS We established a real-world ambispective cohort study of all live births in delivery rooms with gestational age (GA) between 24+0 and 27+6 weeks from 2010 to 2019. RESULTS Of the 1163 EPIs included in our study, 241 (20.7%) survived, while 849 (73.0%) died in the delivery room and 73 (6.3%) died in the neonatal intensive care unit. Among all included EPIs, 862 (74.1%) died from withholding or withdrawal of care. Regardless of stratification according to GA or birth weight, the proportion of total mortality attributable to withdrawal of care is high. For infants with the GA of 24 weeks, active treatment did not extend their survival time (P = 0.224). The survival time without severe morbidity of the active treatment was significantly longer than that of withdrawing care for infants older than 25 weeks (P < 0.001). Over time, the survival rate improved, and the withdrawal of care caused by socioeconomic factors and primary nonintervention were reduced significantly (P < 0.001). CONCLUSIONS The mortality rate of EPIs is still high. Withdrawal of care is common for EPIs with smaller GA, especially in the delivery room. It is necessary to use a multi-center, large sample of real-world data to find the survival limit of active treatment based on our treatment capabilities.
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Affiliation(s)
- Wen-Wen Zhang
- grid.460018.b0000 0004 1769 9639Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021 China
| | - Yong-Hui Yu
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
| | - Xiao-Yu Dong
- grid.508193.6Department of Neonatology, Shandong Maternal and Child Health Hospital, Jinan, 250021 China
| | - Simmy Reddy
- grid.27255.370000 0004 1761 1174Cheeloo College of Medicine, Shandong University, Jinan, China
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Factors Associated with Treatment Outcome of Preterm Babies at Discharge from the Neonatal Intensive Care Unit (NICU) of the Tamale Teaching Hospital, Ghana. Int J Pediatr 2020; 2020:5696427. [PMID: 32908553 PMCID: PMC7474387 DOI: 10.1155/2020/5696427] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 07/14/2020] [Accepted: 08/04/2020] [Indexed: 12/19/2022] Open
Abstract
Background Preterm birth and complications are now the leading cause of death in children under 5 years globally. In Ghana, studies assessing the survival rate of preterm babies and associated factors in Neonatal Intensive Care Units (NICU) are limited. Therefore, this study was designed to assess the survival rate and associated factors in this group of babies in a teaching hospital in the Northern Region of Ghana. Methods This was a 7-month retrospective descriptive study conducted in the NICU of the Tamale Teaching Hospital, Ghana. It involved review of charts of all preterm babies admitted between 1 March 2017 and 30 September 2017. Data retrieved from all eligible patients was analyzed using Stata version 12.1 software to generate descriptive statistics. Relationship between dependent and independent variables was tested using Pearson chi square. A logistic regression model was estimated to assess determinants of the treatment outcome. Results The overall survival rate at discharge in this cohort was 60.73%. The survival rate was lowest in the extremely low birth weight group (3/21; 14.3%) and extremely preterm babies (4/20; 20%). Significant association was observed between birth weight (P = 0.0001), gestational age (P = 0.0001), and survival. Preterm babies who were hypothermic at presentation, had respiratory distress syndrome, and had jaundice were 7.2 times (AOR = 7.2; 95%CI = 1.9‐28.1; P = 0.004), 10.2 times (AOR = 10.2; 95%CI = 3.7‐27.9; P ≤ 0.0001), and 2.9 times (AOR = 2.9; 95%CI = 1.0‐8.5; P = 0.045), respectively, more likely to die on admission compared to neonates who did not have these comorbidities. Conclusion We found a high mortality rate in the preterm babies admitted to our unit, and that mortality rate decreased with increasing gestational age and birth weight. A number of neonatal factors, either in isolation or in combination, were significantly associated with in-hospital mortality.
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Helenius K, Morisaki N, Kusuda S, Shah PS, Norman M, Lehtonen L, Reichman B, Darlow BA, Noguchi A, Adams M, Bassler D, Håkansson S, Isayama T, Berti E, Lee SK, Vento M, Lui K. Survey shows marked variations in approaches to redirection of care for critically ill very preterm infants in 11 countries. Acta Paediatr 2020; 109:1338-1345. [PMID: 31630444 DOI: 10.1111/apa.15069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/03/2019] [Accepted: 10/18/2019] [Indexed: 01/27/2023]
Abstract
AIM We surveyed care practices for critically ill very preterm infants admitted to neonatal intensive care units (NICUs) in the International Network for Evaluating Outcomes in Neonates (iNeo) to identify differences relevant to outcome comparisons. METHODS We conducted an online survey on care practices for critically ill very preterm infants and infants with severe intracranial haemorrhage (ICH). The survey was distributed in 2015 to representatives of 390 NICUs in 11 countries. Survey replies were compared with network incidence of death and severe ICH for infants born between 230/7 and 286/7 weeks of gestation from January 1, 2015, to December 31, 2015. RESULTS Most units in Israel, Japan and Tuscany, Italy, favoured withholding care when care was considered futile, whereas most units in other networks favoured redirection of care. For infants with bilateral grade 4 ICH, redirection of care was very frequently (≥90% of cases) offered in the majority of units in Australia and New Zealand and Switzerland, but rarely in other networks. Networks where redirection of care was frequently offered for severe ICH had lower rates of survivors with severe ICH. CONCLUSION We identified marked inter-network differences in care approaches that need to be considered when comparing outcomes.
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Affiliation(s)
- Kjell Helenius
- Department of Paediatrics and Adolescent Medicine Turku University Hospital and University of Turku Turku Finland
| | - Naho Morisaki
- Department of Social Medicine Neonatal Research Network Japan National Center for Child Health and Development Tokyo Japan
| | - Satoshi Kusuda
- Neonatal Research Network Japan Maternal and Perinatal Center Tokyo Women's Medical University Tokyo Japan
| | - Prakesh S. Shah
- Department of Paediatrics Mount Sinai Hospital and University of Toronto Toronto Canada
- Maternal‐Infant Care Research Centre Mount Sinai Hospital Toronto Canada
| | - Mikael Norman
- Department of Neonatal Medicine Karolinska University Hospital and Karolinska Institutet Stockholm Sweden
| | - Liisa Lehtonen
- Department of Paediatrics and Adolescent Medicine Turku University Hospital and University of Turku Turku Finland
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research Sheba Medical Centre Tel Hashomer Israel
| | - Brian A. Darlow
- Department of Paediatrics University of Otago Christchurch New Zealand
| | | | - Mark Adams
- Department of Neonatology University Hospital Zurich University of Zurich Zurich Switzerland
| | - Dirk Bassler
- Department of Neonatology University Hospital Zurich University of Zurich Zurich Switzerland
| | - Stellan Håkansson
- Department of Clinical Sciences/Pediatrics Umeå University Hospital Umeå Sweden
| | - Tetsuya Isayama
- Division of Neonatology National Center for Child Health and Development Tokyo Japan
| | - Elettra Berti
- Neonatal Intensive Care Unit Anna Meyer Children’s University Hospital Florence Italy
| | - Shoo K. Lee
- Department of Paediatrics Mount Sinai Hospital and University of Toronto Toronto Canada
- Maternal‐Infant Care Research Centre Mount Sinai Hospital Toronto Canada
- Department of Obstetrics and Gynecology and Dalla Lana School of Public Health University of Toronto Toronto Canada
| | - Maximo Vento
- Division of Neonatology and Health Research Institute La Fe Valencia Spain
| | - Kei Lui
- Royal Hospital for Women National Perinatal Epidemiology and Statistic Unit University of New South Wales Randwick NSW Australia
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Azami M, Jasemi S, Khalifpur Y, Badfar G. Causes of mortality in a neonatal intensive care unit in Iran: one year data. MEDICAL JOURNAL OF INDONESIA 2020. [DOI: 10.13181/mji.oa.203449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Neonatal mortality rate is a major health index. Approximately, 65% of all deaths in the first year of life occur during this 4-week period. The present study was conducted to investigate the mortality rates and causes of death in a neonatal intensive care unit (NICU) in Ahvaz, Iran in a year.
METHODS This cross-sectional study was conducted in the NICU of Sina Hospital in Ahvaz. Medical records were studied, and data from 1,040 newborns admitted to the NICU within one year (March 2016 to March 2017) were collected following a checklist. Of these newborns, 123 died, and their relevant data were collected. Data were analyzed using SPSS, version 20 (SPSS Inc., USA).
RESULTS The mortality rate was 11.82% (123 cases) out of 1,040 newborns admitted to NICU. Most of the newborns (48.8%) died on days 1–7. The causes of death were respiratory distress syndrome (RDS) (34.1%), asphyxia (25.2%), anomalies (10.6%), sepsis (7.3%), intracerebral hemorrhage (8.1%), pulmonary hemorrhage (7.3%), and other causes (6.4%), such as hydrops, severe pneumothorax, severe renal failure, and others.
CONCLUSIONS The mortality rate in the NICU of this center was similar to that in other Iranian provinces. The most common causes of NICU mortality included prematurity and its complications, such as asphyxia and RDS. Thus, a strategic plan for reducing preterm delivery and asphyxia are necessary.
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Yu YH, Wang L, Huang L, Wang LL, Huang XY, Fan XF, Ding YJ, Zhang CY, Liu Q, Sun AR, Zhao YH, Yao G, Li C, Liu XX, Wu JC, Yang ZY, Chen T, Ren XY, Li J, Bi MR, Peng FD, Geng M, Qiu BP, Zhao RM, Niu SP, Zhu RX, Chen Y, Gao YL, Deng LP. Association between admission hypothermia and outcomes in very low birth weight infants in China: a multicentre prospective study. BMC Pediatr 2020; 20:321. [PMID: 32600275 PMCID: PMC7322890 DOI: 10.1186/s12887-020-02221-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background The objective of this prospective, multicentre, observational cohort study was to evaluate the association between admission hypothermia and neonatal outcomes in very low-birth weight (VLBW) infants in multiple neonatal intensive care units (NICUs) in China. Methods Since January 1, 2018, a neonatal homogeneous cooperative research platform-Shandong Neonatal Network (SNN) has been established. The platform collects clinical data in a prospective manner on preterm infants with birth weights (BWs) < 1500 g and gestational ages (GAs) < 34 weeks born in 28 NICUs in Shandong Province. These infants were divided into normothermia, mild or moderate/severe hypothermia groups according to the World Health Organization (WHO) classifications of hypothermia. Associations between outcomes and hypothermia were tested in a bivariate analysis, followed by a logistic regression analysis. Results A total of 1247 VLBW infants were included in this analysis, of which 1100 infants (88.2%) were included in the hypothermia group, 554 infants (44.4%) in the mild hypothermia group and 546 infants (43.8%) in the moderate/severe hypothermia group. Small for gestational age (SGA), caesarean section, a low Apgar score at 5 min and intubation in the delivery room (DR) were related to admission hypothermia (AH). Mortality was the lowest when their admission temperature was 36.5 ~ 37.5 °C, and after adjustment for maternal and infant characteristics, mortality was significantly associated with AH. Compared with infants with normothermia (36.5 ~ 37.5 °C), the adjusted ORs of all deaths increased to 4.148 (95% CI 1.505–11.437) and 1.806 (95% CI 0.651–5.009) for infants with moderate/severe hypothermia and mild hypothermia, respectively. AH was also associated with a high likelihood of respiratory distress syndrome (RDS), intraventricular haemorrhage (IVH), and late-onset neonatal sepsis (LOS). Conclusions AH is still very high in VLBW infants in NICUs in China. SGA, caesarean section, a low Apgar score at 5 min and intubation in the DR were associated with increased odds of hypothermia. Moderate/severe hypothermia was associated with mortality and poor outcomes, such as RDS, IVH, LOS.
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Affiliation(s)
- Yong-Hui Yu
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University and Shandong University, No. 234, Jingwu Road, Huai Yin District, Jinan, 250021, Shandong, China.
| | - Li Wang
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University and Shandong University, No. 234, Jingwu Road, Huai Yin District, Jinan, 250021, Shandong, China
| | - Lei Huang
- Shandong Provincial Maternity and Child Health Care Hospital, Jinan, China
| | - Li-Ling Wang
- Qianfo Shan Hospital Affiliated to Shandong University, Jinan, China
| | | | - Xiu-Fang Fan
- Jinan Maternity and Child Health Care Hospital, Jinan, China
| | | | - Cheng-Yuan Zhang
- Weifang Maternity and Child Health Care Hospital, Weifang, China
| | - Qiang Liu
- Linyi People's Hospital, Linyi, China
| | - Ai-Rong Sun
- Linyi Women's and Children's Hospital, Linyi, China
| | - Yue-Hua Zhao
- Affiliated Hospital of Weifang Medical College, Weifang, China
| | - Guo Yao
- Taian Central Hospital, Taian, China
| | - Cong Li
- Liaocheng People's Hospital, Liaocheng, China
| | | | - Jing-Cai Wu
- Zaozhuang Maternity and Child Health Care Hospital, Zaozhuang, China
| | - Zhen-Ying Yang
- Taian Maternity and Child Health Care Hospital, Taian, China
| | - Tong Chen
- Dongying People's Hospital, Dongying, China
| | - Xue-Yun Ren
- Affiliated Hospital of Jining Medical College, Jining, China
| | - Jing Li
- The Second Affiliated Hospital of Shandong First Medical University, Jinan, China
| | | | - Fu-Dong Peng
- Liaocheng Second People's Hospital, Liaocheng, China
| | - Min Geng
- Jinan Second Maternity and Child Health Care Hospital, Jinan, China
| | | | | | - Shi-Ping Niu
- Zibo Maternity and Child Health Care Hospital, Zibo, China
| | - Ren-Xia Zhu
- People's Hospital of Linzi District, Zibo, China
| | - Yao Chen
- Central Hospital of Shandong Provincial Affiliated to Shandong University, Jinan, China
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Bioethical Decisions in Neonatal Intensive Care: Neonatologists' Self-Reported Practices in Greek NICUs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103465. [PMID: 32429230 PMCID: PMC7277706 DOI: 10.3390/ijerph17103465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/11/2020] [Accepted: 05/14/2020] [Indexed: 01/27/2023]
Abstract
This study presents, for the first time, empirical data on practices regarding bioethical decision-making in treatment of preterm and ill newborns in Greece. The aim of the study was to: (a) record self-reported practices and involvement of Greek physicians in decisions of withholding and withdrawing neonatal intensive care, and (b) explore the implication of cultural, ethical, and professional parameters in decision-making. Methods: 71 physicians, employed fulltime in all public Neonatal Intensive Care Units (NICUs) (n = 17) in Greece, completed an anonymous questionnaire between May 2009 and May 2011. Results: One-third of the physicians in our sample admitted that they have, at least once in the past, decided the limitation of intensive care of a newborn close to death (37.7%) and/or a newborn with unfavorable neurological prognosis (30.8%). The higher the physicians’ support towards the value of quality of human life, the more probable it was that they had taken a decision to withhold or withdraw neonatal intensive care (p < 0.05). Conclusions: Our research shows that Greek NICU physicians report considerably lower levels of ethical decision-making regarding preterm and ill newborns compared to their counterparts in other European countries. Clinical practices and attitudes towards ethical decision-making appear to be influenced mainly by the Greek physicians’ values.
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Yotani N, Nabetani M, Feudtner C, Honda J, Kizawa Y, Iijima K. Withholding and withdrawal of life-sustaining treatments for neonate in Japan: Are hospital practices associated with physicians' beliefs, practices, or perceived barriers? Early Hum Dev 2020; 141:104931. [PMID: 31810052 DOI: 10.1016/j.earlhumdev.2019.104931] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the current status of withholding or withdrawal of life-sustaining interventions (LSI) for neonates in Japan and to identify physician- and institutional-related factors that may affect advance care planning (ACP) practices with parents. STUDY DESIGN A self-reported questionnaire was administered to assess frequency of withholding and withdrawing intensive care at the respondent's facility, the physician's degree of affirming various beliefs about end-of-life care that was compared to 7 European countries, their self-reported ACP practices and perceived barriers to ACP. Three neonatologists at all 298 facilities accredited by the Japan Society for Neonatal Health and Development were surveyed, with 572 neonatologists at 217 facilities responding. RESULTS At 76% of facilities, withdrawing intensive care treatments was "never" done, while withholding intensive care had been done "sometimes" or more frequently at 82% of facilities. Japanese neonatologists differed from European neonatologists regarding their degree of affirmation of 3 out of 7 queried beliefs about end-of-life care. In hospitals that were more likely to "sometimes" (or more often) withdraw treatments, respondents were less likely to affirm beliefs about doing "everything possible" or providing the "maximum of intensive care". Self-reported ACP practices did not vary between neonatologists based on their hospital's overall pattern of withholding or withdrawing treatments. CONCLUSION Among NICU facilities in Japan, 21% had been sometimes withdrawing LSI and 82% had been "sometimes" withholding LSI. Institutional treatment practices may have a strong association with physicians' beliefs that then affect end-of-life discussions, but not with self-reported ACP practices.
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Affiliation(s)
- Nobuyuki Yotani
- Department of Palliative Medicine, National Centre for Child Health and Development, Tokyo, Japan.
| | | | - Chris Feudtner
- Department Medical Ethics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Junko Honda
- College of Nursing Art and Science, University of Hyogo, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
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Nurses' Perceptions of the Palliative Care Needs of Neonates With Multiple Congenital Anomalies. J Hosp Palliat Nurs 2020; 22:137-144. [DOI: 10.1097/njh.0000000000000628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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18
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Beksac MS, Fadiloglu E, Unal C, Cetiner S, Tanacan A. 5-year experience of a tertiary center in major congenital abnormalities in singleton pregnancies. Birth Defects Res 2020; 112:633-639. [PMID: 31926058 DOI: 10.1002/bdr2.1645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/11/2019] [Accepted: 12/26/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To demonstrate major congenital abnormalities delivered or terminated at our institution between 2014 and 2018. MATERIALS AND METHODS Necessary information was retrieved from the registries of the delivery room and electronic database of Hacettepe University Hospital, Ankara. RESULTS This study was consisted of 307 major congenital anomalies. The incidence of major congenital anomalies was 2.9 per 1,000 live births, while the majority of the cases were related to cardiovascular, central nervous system, and diaphragmatic hernia with 97, 87, and 25 cases at each group, respectively. Rate of termination of pregnancy (TOP) and live birth were 35.1 and 59.2%, respectively. The overall infant mortality rate was 28.9% in cases with live birth, while this rate was highest in cardiovascular system abnormalities and diaphragmatic hernia. Out of 182 newborns, 92.8% admitted to the neonatal intensive care unit after the delivery. Median gestational week at TOP was 21(20). CONCLUSION We have shown that TOP and infant mortality rates were 35.1 and 28.9%, respectively in pregnancies with fetal malformations. Detailed multidisciplinary counseling must be provided for parents in pregnancies with major congenital abnormalities.
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Affiliation(s)
- M Sinan Beksac
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Erdem Fadiloglu
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Canan Unal
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Sibel Cetiner
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
| | - Atakan Tanacan
- Division of Perinatology, Department of Obstetrics and Gynecology, Hacettepe University, Ankara, Turkey
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Abdel Razeq NM, Alduraidi H, Halasa S, Cuttini M. Clinicians' Self-Reported Practices Related to End-of-Life Care for Infants in NICUs in Jordan. J Obstet Gynecol Neonatal Nurs 2019; 49:78-90. [PMID: 31811824 DOI: 10.1016/j.jogn.2019.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine how clinical decisions are made at the end of life for infants born with specific fatal and disabling conditions in NICUs in Jordan from the perspectives of neonatal health care providers. DESIGN A cross-sectional survey of neonatal nurses and physicians. SETTING Twenty-four NICUs in Jordan. PARTICIPANTS Participants included 213 nurses and 75 physicians who provided direct care for infants in NICUs. METHODS Using the EURONIC questionnaire, we asked participants to recall the last experiences of end-of-life decision making in which they were involved. The participants described factors and outcomes related to those experiences, and we used descriptive and inferential statistics to examine these factors. RESULTS In 83% of the recalled situations, the physicians in charge of the infants' care or who were on duty were the primary decision makers. Parents, nurses, ethics committees, and NICU heads were less involved. The infants' primary diagnoses were significantly associated with the nature of decisions regarding end-of-life care (p < .001). Age, importance of religion, having their own children, and involvement in research activities were factors that significantly predicted nurses' perceived levels of involvement in decision making (χ2[4] = 23.140, p < .001). CONCLUSION Our results suggest the need to improve clinical approaches to decision making regarding end-of-life care for infants in NICUs in Jordan to be more family focused and team based. This process should include parents, physicians, neonatal nurses, and ethics committees.
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Abdel Razeq NM. Physicians' standpoints on end-of-life decisions at the neonatal intensive care units in Jordan. J Child Health Care 2019; 23:579-595. [PMID: 30606043 DOI: 10.1177/1367493518814926] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The purpose of this cross-sectional descriptive study is to explore pediatricians' and neonatologists' attitudes and standpoints on end-of-life (EOL) decision-making in neonates. Seventy-five physicians, employed fulltime to care for newborns in 23 hospitals in Jordan, completed internationally accepted questionnaires. Most physicians (75%) were supportive of using life-sustaining interventions, irrespective of the severity of the newborns' prognosis and the potential burden of the neonates' disabilities on their families. The general attitude of the physicians (59-88%) was against making decisions that limit life support at EOL; even those infants with what are, in fact, untreatable and disabling medical conditions (56-88%). Most physicians (77%) indicated that ethics committees should be involved in EOL decision-making based on requests from parents, physicians, or both. The results of this study indicate strong pro-life attitudes among the physicians whose role is to take care of infants in Jordan. The results also emphasize the need for (1) the creation of clear EOL-focused regulations and guidelines, (2) the establishment of special ethical committees to inform and assist healthcare providers' efforts during EOL care, and (3) raised awareness and competencies regarding EOL and ethical decision-making among physicians taking care of newborns in Jordan's intensive care units.
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Affiliation(s)
- Nadin M Abdel Razeq
- Department of Maternal and Child Health Nursing, School of Nursing, The University of Jordan, Amman, Jordan
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Kim S, Savage TA, Hershberger PE, Kavanaugh K. End-of-Life Care in Neonatal Intensive Care Units from an Asian Perspective: An Integrative Review of the Research Literature. J Palliat Med 2019; 22:848-857. [PMID: 30632880 DOI: 10.1089/jpm.2018.0304] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: End-of-life (EOL) care in neonatal intensive care units (NICUs) can vary depending on religious beliefs of health care providers and families as well as the sociocultural environment. Although guidelines exist for EOL care in NICUs, most are based on Western studies, and little is known about such care in Asian countries, which have different religious and social background. Objective: This review synthesized empirical research to reveal the state of the science on infant EOL care in Asian countries. Design: This was an integrative review. Setting/Subjects: Data were collected from studies identified in CINAHL, Embase, PsycINFO, and PubMed. The search was limited to current empirical studies involving infant EOL care in Asian countries and published in English between 2007 and 2016. Results: Of 286 studies initially identified, 11 empirical studies conducted in Hong Kong, India, Israel, Japan, Mongolia, Taiwan, and Turkey were included in the review. Four themes were captured: factors influencing decision making, trends in decision making, practical aspects of EOL care, and health care providers' preparation. In most NICUs, health care providers controlled decisions regarding use of life-sustaining treatment, with parents participating in decision making no more than 60% of the time. Although care decisions were gradually changing from "do everything" for patient survival to a more palliative approach, comfort care at the EOL was chosen no more than 63% of the time. Conclusion: While infant EOL care practice and research vary by country, few articles address these matters in Asia. This integrative review characterizes infant EOL care in Asia and explores cultural influences on such care.
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Affiliation(s)
- Sujeong Kim
- 1 Department of Nursing, College of Nursing, Seattle University, Seattle, Washington
| | - Teresa A Savage
- 2 Department of Women, Children, and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Patricia E Hershberger
- 3 Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Karen Kavanaugh
- 2 Department of Women, Children, and Family Health Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois.,4 Department of Nursing Research, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
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Abdel Razeq NM. End-of-life Decisions at Neonatal Intensive Care Units: Jordanian Nurses Attitudes and Viewpoints of Who, When, and How. J Pediatr Nurs 2019; 44:e36-e44. [PMID: 30420167 DOI: 10.1016/j.pedn.2018.10.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 10/04/2018] [Accepted: 10/20/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE To explore factors predicting neonatal nurses' attitude towards end-of-life decisions in neonates, and to describe the nurses' viewpoints on end-of-life decisions; barriers to end-of-life decision making; parents', nurses', and ethical committees' involvement in the process of end-of-life decision making; and who should regulate end-of-life decisions regarding neonates. DESIGN AND METHODS A cross-sectional descriptive correlational design was applied. Sample included 279 neonatal nurses working in 24 neonatal intensive care units across Jordan. Data were collected using internationally-accepted questionnaires. Descriptive and inferential statistics were applied in data analysis. RESULTS Most nurses perceived that everything possible should be done to ensure a neonate's survival, even when they suffer severe prognosis (80%) and irrespective of the burden of the child's disability on the family (75%). Almost all nurses (96%) were against administering drugs with the purpose of ending the neonate's life and 63% were against continuing current treatment without adding others. The nurses' perceived effect of end-of-life decisions on their everyday life, and the importance of religious values to the nurses' personal lives, significantly predicted pro-life attitude scores. According to 80% of the nurses, legal constraints were the most significant barriers to end-of-life decision making. The majority of nurses (84%) indicated that non-religious bodies should establish end-of-life regulations for neonates. CONCLUSION Generally, nurses' attitude was supportive of life saving decisions at end-of-life, regardless of the survival odds and the probable health outcomes of the neonates. PRACTICE IMPLICATIONS Neonates' end-of-life care, and parents' bereavement care, should be standard practices in every NICU, worldwide.
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Affiliation(s)
- Nadin M Abdel Razeq
- The University of Jordan - School of Nursing, Maternal and Child Health Nursing Department, Amman Jordan.
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Verhagen AAE. Why Do Neonatologists in Scandinavian Countries and the Netherlands Make Life-and-death Decisions So Different? Pediatrics 2018; 142:S585-S589. [PMID: 30171145 DOI: 10.1542/peds.2018-0478j] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2018] [Indexed: 11/24/2022] Open
Abstract
An examination of the policies regarding the care of extremely premature newborns reveals unexpected differences between Scandinavian countries and the Netherlands. Three topics related to decision-making at the beginning and at the end of life are identified and discussed.
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Affiliation(s)
- A A Eduard Verhagen
- Department of Pediatrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Helenius K, Sjörs G, Shah PS, Modi N, Reichman B, Morisaki N, Kusuda S, Lui K, Darlow BA, Bassler D, Håkansson S, Adams M, Vento M, Rusconi F, Isayama T, Lee SK, Lehtonen L. Survival in Very Preterm Infants: An International Comparison of 10 National Neonatal Networks. Pediatrics 2017; 140:peds.2017-1264. [PMID: 29162660 DOI: 10.1542/peds.2017-1264] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare survival rates and age at death among very preterm infants in 10 national and regional neonatal networks. METHODS A cohort study of very preterm infants, born between 24 and 29 weeks' gestation and weighing <1500 g, admitted to participating neonatal units between 2007 and 2013 in the International Network for Evaluating Outcomes of Neonates. Survival was compared by using standardized ratios (SRs) comparing survival in each network to the survival estimate of the whole population. RESULTS Network populations differed with respect to rates of cesarean birth, exposure to antenatal steroids and birth in nontertiary hospitals. Network SRs for survival were highest in Japan (SR: 1.10; 99% confidence interval: 1.08-1.13) and lowest in Spain (SR: 0.88; 99% confidence interval: 0.85-0.90). The overall survival differed from 78% to 93% among networks, the difference being highest at 24 weeks' gestation (range 35%-84%). Survival rates increased and differences between networks diminished with increasing gestational age (GA) (range 92%-98% at 29 weeks' gestation); yet, relative differences in survival followed a similar pattern at all GAs. The median age at death varied from 4 days to 13 days across networks. CONCLUSIONS The network ranking of survival rates for very preterm infants remained largely unchanged as GA increased; however, survival rates showed marked variations at lower GAs. The median age at death also varied among networks. These findings warrant further assessment of the representativeness of the study populations, organization of perinatal services, national guidelines, philosophy of care at extreme GAs, and resources used for decision-making.
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Affiliation(s)
- Kjell Helenius
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu, Turku, Finland; .,Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Gunnar Sjörs
- National Quality Registry for Neonatal Care, Department of Pediatrics/Neonatal Services, University Hospital of Umeå, Umeå, Sweden
| | - Prakesh S Shah
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Neena Modi
- United Kingdom Neonatal Collaborative, Neonatal Data Analysis Unit, and Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Brian Reichman
- Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel
| | - Naho Morisaki
- Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Satoshi Kusuda
- Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - Kei Lui
- Royal Hospital for Women, and National Perinatal Epidemiology and Statistics Unit, University of New South Wales, Randwick, Australia
| | - Brian A Darlow
- Department of Pediatrics, University of Otago, Christchurch, New Zealand
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stellan Håkansson
- National Quality Registry for Neonatal Care, Department of Pediatrics/Neonatal Services, University Hospital of Umeå, Umeå, Sweden
| | - Mark Adams
- Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maximo Vento
- Health Research Institute La Fe, Avenida Fernando Abril Martorell, Valencia, Spain; and
| | - Franca Rusconi
- TIN Toscane Online, Unit of Epidemiology, Meyer Children's University Hospital, Florence, Italy and Regional Health Agency of Tuscany, Florence, Italy
| | - Tetsuya Isayama
- Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Shoo K Lee
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Maternal-Infant Care Research Centre, and Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Liisa Lehtonen
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, Kiinamyllynkatu, Turku, Finland.,Department of Clinical Medicine, University of Turku, Turku, Finland
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Koshida S, Yanagi T, Ono T, Tsuji S, Takahashi K. Possible Prevention of Neonatal Death: A Regional Population-Based Study in Japan. Yonsei Med J 2016; 57:426-9. [PMID: 26847296 PMCID: PMC4740536 DOI: 10.3349/ymj.2016.57.2.426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/06/2015] [Accepted: 07/06/2015] [Indexed: 12/01/2022] Open
Abstract
PURPOSE The neonatal mortality rate in Japan has currently been at the lowest level in the world. However, it is unclear whether there are still some potentially preventable neonatal deaths. We, therefore, aimed to examine the backgrounds of neonatal death and the possibilities of prevention in a region of Japan. MATERIALS AND METHODS This is a population-based study of neonatal death in Shiga Prefecture of Japan. RESULTS The 103 neonatal deaths in our prefecture between 2007 and 2011 were included. After reviewing by a peer-review team, we classified the backgrounds of these neonatal deaths and analyzed end-of-life care approaches associated with prenatal diagnosis. Furthermore, we evaluated the possibilities of preventable neonatal death, suggesting specific recommendations for its prevention. We analyzed 102 (99%) of the neonatal deaths. Congenital malformations and extreme prematurity were the first and the second most common causes of death, respectively. More than half of the congenital abnormalities (59%) including malformations and chromosome abnormality had been diagnosed before births. We had 22 neonates with non-intensive care including eighteen cases with congenital abnormality and four with extreme prematurity. Twenty three cases were judged to have had some possibility of prevention with one having had a strong possibility of prevention. Among specific recommendations of preventable neonatal death, more than half of them were for obstetricians. CONCLUSION There is room to reduce neonatal deaths in Japan. Prevention of neonatal death requires grater prenatal care by obstetricians before birth rather than improved neonatal care by neonatologists after birth.
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Affiliation(s)
- Shigeki Koshida
- Department of Community Perinatal Medicine, Shiga University of Medical Science, Otsu, Japan.
| | - Takahide Yanagi
- Department of Pediatrics, Shiga University of Medical Science, Otsu, Japan
| | - Tetsuo Ono
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Shunichiro Tsuji
- Department of Obstetrics and Gynecology, Shiga University of Medical Science, Otsu, Japan
| | - Kentaro Takahashi
- Department of Community Perinatal Medicine, Shiga University of Medical Science, Otsu, Japan
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26
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Park GY, Kim SS. Deaths in the Neonatal Intensive Care Unit between 2002 and 2014. NEONATAL MEDICINE 2016. [DOI: 10.5385/nm.2016.23.1.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ga Young Park
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Sung Shin Kim
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Korea
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Chow S, Chow R, Popovic M, Lam M, Popovic M, Merrick J, Stashefsky Margalit RN, Lam H, Milakovic M, Chow E, Popovic J. A Selected Review of the Mortality Rates of Neonatal Intensive Care Units. Front Public Health 2015; 3:225. [PMID: 26501049 PMCID: PMC4595739 DOI: 10.3389/fpubh.2015.00225] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/22/2015] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Newborn babies in need of critical medical attention are normally admitted to the neonatal intensive care unit (NICU). These infants tend to be preterm, have low birth weight, and/or have serious medical conditions. Neonatal survival varies, but progress in perinatal and neonatal care has notably diminished mortality rates. In this selected review, we examine and compare the NICU mortality rates and etiologies of death in different countries. METHODS A literature search was conducted in Ovid MEDLINE, OLDMEDLINE, EMBASE Classic, and EMBASE. The primary endpoint was the mortality rates in NICUs. Secondary endpoints included the reasons for death and the correlation between infant age and mortality outcome. For the main analysis, we examined all infants admitted to NICUs. Subgroup analyses included extremely low birth weight infants (based on the authors' own definition), very low birth weight infants, very preterm infants, preterm infants, preterm infants with a birth weight of ≤1,500 g, and by developed and developing countries. RESULTS The literature search yielded 1,865 articles, of which 20 were included. The total mortality rates greatly varied among countries. Infants in developed and developing countries had similar ages at death, ranging from 4 to 20 days and 1 to 28.9 days, respectively. The mortality rates ranged from 4 to 46% in developed countries and 0.2 to 64.4% in developing countries. CONCLUSION The mortality rates of NICUs vary between nations but remain high in both developing and developed countries.
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Affiliation(s)
- Selina Chow
- Toronto East General Hospital , Toronto, ON , Canada
| | - Ronald Chow
- Toronto East General Hospital , Toronto, ON , Canada
| | - Mila Popovic
- Toronto East General Hospital , Toronto, ON , Canada
| | - Michael Lam
- Sunnybrook Health Sciences Centre , Toronto, ON , Canada
| | - Marko Popovic
- Toronto East General Hospital , Toronto, ON , Canada
| | - Joav Merrick
- Health Services, Division for Intellectual and Developmental Disabilities, National Institute of Child Health and Human Development, Ministry of Social Affairs , Jerusalem , Israel
| | - Ruth Naomi Stashefsky Margalit
- MSR Israel Center for Medical Simulation, Chaim Sheba Medical Center, Tel Hashomer National Education Center , Ramat Gan , Israel
| | - Henry Lam
- Sunnybrook Health Sciences Centre , Toronto, ON , Canada
| | | | - Edward Chow
- Sunnybrook Health Sciences Centre , Toronto, ON , Canada
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Abstract
BACKGROUND Most deaths in severely brain-injured newborns in neonatal intensive care units (NICUs) follow discussions and explicit decisions to limit life-sustaining treatment. There is little published information on such discussions. OBJECTIVE To describe the prevalence, nature and outcome of treatment limitation discussions (TLDs) in critically ill newborns with severe brain injury. DESIGN A retrospective statewide cohort study. SETTING Two tertiary NICUs in South Australia. PATIENTS Ventilated newborns with severe hypoxic ischaemic encephalopathy and periventricular/intraventricular haemorrhage (P/IVH) admitted over a 6-year period from 2001 to 2006. MAIN OUTCOME MEASURES Short-term outcome (until hospital discharge) including presence and content of TLDs, early childhood mortality, school-age functional outcome. RESULTS We identified 145 infants with severe brain injury; 78/145 (54%) infants had documented TLDs. Discussions were more common in infants with severe P/IVH or hypoxic-ischaemic encephalopathy (p<0.01). Fifty-six infants (39%) died prior to discharge, all following treatment limitation. The majority of deaths (41/56; 73%) occurred in physiologically stable infants. Of 78 infants with at least one documented TLD, 22 (28%) survived to discharge, most in the setting of explicit or inferred decisions to continue treatment. Half of long-term survivors after TLD (8/16, 50%) were severely impaired at follow-up. However, two-thirds of surviving infants with TLD in the setting of unilateral P/IVH had mild or no disability. CONCLUSIONS Some critically ill newborn infants with brain injury survive following TLDs between their parents and physicians. Outcome in this group of infants provides valuable information about the integrity of prognostication in NICU, and should be incorporated into counselling.
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Affiliation(s)
- Marcus Brecht
- Women's and Children's Hospital, Adelaide, Australia,Flinders Medical Centre, Adelaide, Australia
| | - Dominic J C Wilkinson
- Women's and Children's Hospital, Adelaide, Australia,Faculty of Philosophy, Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, UK,Robinson Institute, Discipline of Obstetrics and Gynaecology, University of Adelaide, Adelaide, Australia,John Radcliffe Hospital, Oxford, UK
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Abstract
Infants born at the limits of viability present neonatologists in particular and society in general with difficult challenges. Ethical and legal considerations establish a framework for action, although this varies between countries, departments and individuals and shows dynamic changes over time. This brief review includes a vignette telling a familiar story. In this case, the parents ask searching questions and the caring, knowledgeable neonatologist uses up-to-date information to offer empathic and thoughtful guidance - a challenge for all.
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Affiliation(s)
- Eric S Shinwell
- Department of Neonatology, Ziv Medical Center, Bar-Ilan University, Tsfat, Israel
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30
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Finn D, Collins A, Murphy BP, Dempsey EM. Mode of neonatal death in an Irish maternity centre. Eur J Pediatr 2014; 173:1505-9. [PMID: 24916041 DOI: 10.1007/s00431-014-2356-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/27/2014] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Modes of neonatal dying vary among maternity centres, both within and between countries. There have been few reports concerning mode of dying from countries with low rates of termination of pregnancy, such as Ireland. We conducted a retrospective chart review of all neonatal deaths, between January 2010 and January 2013, within a single Irish maternity centre. The mode of dying was classified as one of (1) withholding life-sustaining treatment (LST), (2) withdrawal of LST in moribund infants, (3) withdrawal of LST for quality of life reasons or (4) death despite maximal intensive care treatment. There were a total of 64 deaths during the study period. Congenital abnormalities accounted for 47 % of deaths and prematurity for 41 % of deaths. Withholding LST was the most frequent mode of dying, occurring in 38 % of all deaths. A total of 12 % of neonatal deaths occurred despite maximal intensive care treatment. CONCLUSIONS Congenital abnormalities were the most common cause of neonatal deaths. A high proportion followed LST being withheld, most likely a reflection of the low rates of medical termination in Ireland. Modes of dying in the neonatal period vary between maternity centres with culturally different backgrounds.
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Affiliation(s)
- Daragh Finn
- Department of Paediatrics and Child Health, Neonatal Intensive Care Unit, University College Cork, Cork, Ireland,
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