Medical Futility Trend Seen in Neonatal Deaths
TUESDAY July 5, 2011 -- Most deaths that occur in neonatal intensive care units at U.S. hospitals are due to withdrawal of life support and the withholding of lifesaving measures, a new study reveals.
Neonatal infants (younger than 28 days old) account for the majority of childhood deaths in the United States, and most of those neonatal deaths occur after a decision to withdraw or withhold life-sustaining treatment, according to background information in the study, which is published in the July issue of the journal Archives of Pediatrics and Adolescent Medicine.
Research conducted in the past three decades showed that an increasing number of American parents are deciding to forgo life-sustaining treatment at the end of their child's life, and there has also been a rise in the number of children with do-not-resuscitate orders, the study authors noted.
In order to find out if such trends are continuing, Dr. Julie Weiner, of Children's Mercy Hospital in Kansas City, Mo., and colleagues examined the medical records of 414 infants who died between January 1999 and December 2008 at a regional referral neonatal intensive care unit (NICU).
Forty-five percent of the infants had major birth defects, and 17 percent of those infants were also very preterm (less than 32 weeks of gestation). Thirty-five percent of the infants were very preterm and had no birth defects, according to the report.
The researchers found that 61.6 percent of infant deaths followed withdrawal of treatment, 20.8 percent followed withholding of treatment, and 17.6 percent died despite attempted cardiopulmonary resuscitation (CPR).
Over the 10-year study period, the number of deaths that occurred after withholding of treatment increased by an average of 1.03 deaths per year. Among very preterm infants, deaths following withholding of treatment increased from less than 10 percent to more than 30 percent.
The researchers also found that the use of CPR at death decreased.
"During the 10-year period, the primary mode of death in this regional referral neonatal intensive care unit was withdrawal of life-sustaining support," the researchers concluded. "Significant increase in withholding of care suggests improved recognition of medical futility and desire to provide a peaceful death."
The Nemours Foundation has more about the NICU.
Posted: July 2011
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