Deaths in the Neonatal Intensive Care Unit between 2002 and 2014

Abstract

Purpose: To report the causes and patterns of death among infants admitted to our neonatal intensive care unit (NICU) over a 13-year period. In addition, we analyzed trends regarding the type of end-of-life care provided. Results: Of the 5,223 admissions to our NICU, 97 neonates died. The overall mortality rate was 1.9%. The most common cause of death was sepsis (15%). At a lower gestational age, infants died of extreme prematurity and complications of prematurity. Among term infants, the principal cause of death shifted to hypoxic ischemic encephalopathy and asphyxia. A total of 63 infants (64.9%) received maximal inten sive care, and 34 infants (35%) had redirection of intensive care. During this period, the proportion of death after redirection of care increased from 30.6% to 39.6%. Infants decided to forgo life-sustaining care before death had significantly lower gestational ages and lower birth weights (30.5 vs. 27.1 weeks, P=0.005; 1,528 vs. 1,063 g, P=0.025). Conclusion: Infection remained an important cause of death for neonate, particularly for preterm infants. The proportion of infants who had redirectoin of care before death was increased, suggesting that quality-of-life should be considered an important factor in the decision-making process for the infant, parents, and medical staff.

Beyond Legal Boundaries: Public and Clinician Perspectives on Treatment Withdrawal in Infants With Poor Neurological Prognosis

“…Research within the Korean NICU suggested that 65–73% of death cases received excessive intensive care, including resuscitation, supporting this claim. 20 21 The current law proclaims the patients’ right to make treatment decisions and their right to dignity. However, decision-making based on ethical considerations remain challenging owing to the restriction of discontinuing LST only during the death-imminent stages of terminal illness.…”

Physicians’ standpoints on end-of-life decisions at the neonatal intensive care units in Jordan

“…Studies have documented the worldwide increment rates of EOLD made in neonatal intensive care units (NICUs) over the past years (Chan et al, 2016; Kim et al, 2018; Michel et al, 2018; Park and Kim, 2016). Rates of EOLDs made at newborns’ EOL were reported to be around 34% in NICUs in Latin America (Fajardo et al, 2012), 54% in Hong Kong (Chan et al, 2016), 63% in the United Kingdom (Aladangady et al, 2017), and between 71% and 81% in Canada (Hellmann et al, 2016; Lam et al, 2016).…”