Short-term outcome of treatment limitation discussions for newborn infants, a multicentre prospective observational cohort study

Aladangady, Narendra; Shaw, Chloë; Gallagher, Katie; Stokoe, Elizabeth; Marlow, Neil

doi:10.1136/archdischild-2016-310723

Cited by 25 publications

(34 citation statements)

References 39 publications

(43 reference statements)

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“…1–4 Physicians and families often discuss withdrawal or withholding of life-sustaining therapy (WWLST) when facing a high likelihood of death, an unacceptable level of suffering, or a poor long-term prognosis. The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN), a consortium of academic centers across the US, maintains a data registry for premature infants born at 22–28 weeks of gestation and/or with extremely low birth weight (401–1000 g).…”

mentioning

confidence: 99%

Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support

James

Munson

DeMauro

et al. 2017

The Journal of Pediatrics

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Objectives To describe the frequency of postnatal discussions about withdrawal or withholding of life-sustaining therapy (WWLST), ensuing WWLST, and outcomes of infants surviving such discussions. We hypothesized that such survivors have poor outcomes. Study design This retrospective review included registry data from 18 centers of the National Institute of Child Health and Human Development Neonatal Research Network. Infants born at 22–28 weeks of gestation who survived >12 hours during 2011–2013 were included. Regression analysis identified maternal and infant factors associated with WWLST discussions and factors predicting ensuing WWLST. In-hospital and 18- to 26-month outcomes were evaluated. Results WWLST discussions occurred in 529 (15.4%) of 3434 infants. These were more frequent at 22–24 weeks (27.0%) compared with 27–28 weeks of gestation (5.6%). Factors associated with WWLST discussion were male sex, gestational age (GA) of ≤24 weeks, birth weight small for GA, congenital malformations or syndromes, early onset sepsis, severe brain injury, and necrotizing enterocolitis. Rates of WWLST discussion varied by center (6.4%–29.9%) as did WWLST (5.2%–20.7%). Ensuing WWLST occurred in 406 patients; of these, 5 survived to discharge. Of the 123 infants for whom intensive care was continued, 58 (47%) survived to discharge. Survival after WWLST discussion was associated with higher rates of neonatal morbidities and neurodevelopmental impairment compared with babies for whom WWLST discussions did not occur. Significant predictors of ensuing WWLST were maternal age >25 years, necrotizing enterocolitis, and days on a ventilator. Conclusions Wide center variations in WWLST discussions occur, especially at ≤24 weeks GA. Outcomes of infants surviving after WWLST discussions are poor. Trial registration ClinicalTrials.gov: NCT00063063.

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confidence: 99%

Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support

James

Munson

DeMauro

et al. 2017

The Journal of Pediatrics

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“…They are less likely to think that being severely disabled is worse than being dead. The results of the WILST study confirm these findings 3. In their study, the categorisation of deaths did not include the physiological stability of children who died,1 which makes some results harder to analyse.…”

Section: How Can We Optimise Communication With Parents? Finding the mentioning

confidence: 69%

“…These differences will have an impact on decision-making. In the WILST study, it was surprising to repeatedly read that ‘parents disagreed’ with limitations of LSI 3. It seems parents were only approached with a recommendation.…”

Section: How Can We Optimise Communication With Parents? Finding the mentioning

confidence: 99%

“…The pendulum has shifted abruptly from paternalism to informed consent where physicians often hesitate to give recommendations. Some parents may prefer honest recommendations, with the understanding that their voice would be heard and choices respected—such as continuing LSI—as described in the WILST study 3. An optimal alternative for decision-making in the grey zone is to engage in discussions with parents in order to understand their values, goals for their baby and decision-making preferences.…”

Section: How Can We Optimise Communication With Parents? Finding the mentioning

confidence: 99%

“…Satisfaction of healthcare providers was strongly associated with the occurrence of parent-child contact, which frequently occurred. Aladangady et al 3 describe the short-term outcome of LSI-limitation discussions with parents in a prospective multicentre trial in the UK (the WILST study). Half of the parents did not agree with providers and opted to continue LSI.…”

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confidence: 99%

See 2 more Smart Citations

End-of-life decisions for fragile neonates: navigating between opinion and evidence-based medicine

Janvier

Farlow

Verhagen

et al. 2016

Arch Dis Child Fetal Neonatal Ed

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Considerations to Guide Treatment Decisions for Infants Born Weighing Less Than 400 g

Lantos

2019

JAMA Pediatr

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show abstract

Short-term outcome of treatment limitation discussions for newborn infants, a multicentre prospective observational cohort study

Cited by 25 publications

References 39 publications

Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support

Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support

End-of-life decisions for fragile neonates: navigating between opinion and evidence-based medicine

Considerations to Guide Treatment Decisions for Infants Born Weighing Less Than 400 g

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