The Contribution of Withholding or Withdrawing Care to Newborn Mortality

Barton, Lorayne; Hodgman, Joan E.

doi:10.1542/peds.2005-0392

Cited by 62 publications

(37 citation statements)

References 6 publications

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“…The findings are consistent with those of previous studies in China, Croatia and Uganda that showed that babies with low Apgar score are more likely to die during the perinatal period (15)(16)(17)(18)(19). Our study showed that nearly a half of the cases (babies who died) were fresh still births.…”

Section: Discussionsupporting

confidence: 93%

Risk Factors For Perinatal Mortality In Arua Regional Referral Hospital, West Nile, Uganda

Akello

Nabiwemba²,

C³

et al. 2009

East Afr. J. Pub. Health

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Background In low-income countries, the majority of neonatal deaths occur during the perinatal period. The fourth millennium development goal of reducing child mortality cannot therefore be met without substantial reduction in perinatal deaths. Objective To investigate the risk factors for perinatal mortality in Arua regional referral hospital, West Nile region. Methods We conducted a facility based unmatched case-control study at Arua Regional Referral hospital during January-March 2006. A total of 60 new cases of perinatal deaths and 120 controls were selected over a 3 months period. A case was defined as any baby born after 28 weeks of gestation either as a still birth or born alive but died within 7 days post delivery. A control was any baby born after 28 weeks of gestation and survived the first seven days of life. Control mothers were followed at home after one week to check if any perinatal death occurred. Logistic regression analysis was used to determine the risk factors for perinatal mortality. Conclusion and Recommendations: Our study has identified several risk factors for perinatal deaths related to poor accessibility to and low quality of health care services in the setting. The study underscores the importance of improved accessibility to and quality of basic and comprehensive emergency obstetrical care. The findings suggest the need to improve the capacity of local health system at first, second and tertiary levels, accessibility to and quality health care services in the settings.

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Section: Discussionsupporting

confidence: 93%

Risk Factors For Perinatal Mortality In Arua Regional Referral Hospital, West Nile, Uganda

Akello

Nabiwemba²,

C³

et al. 2009

East Afr. J. Pub. Health

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“…2 The commonly used lifesustaining practices include maximal intensive care, redirection of intensive care (limited care or withdrawal of care), and primary nonintervention care. [2][3][4][5] However, decision-making practices have been reported to vary widely from country to country and among different institutions in the same country. [6][7][8][9] These differences are mainly related to prognostic uncertainty 10 and combine the interface between the "disease-oriented" and the "person-oriented" approaches, together with the individual case-related circumstances, namely, the family, the medical team, law, and society.…”

mentioning

confidence: 99%

Neonatal End-of-Life Care: A Single-Center NICU Experience in Israel Over a Decade

2013

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WHAT'S KNOWN ON THIS SUBJECT: Neonatal mortality rate and causes of death have been relatively stable in recent years. Decision-making practices preceding death of sick neonates affect the circumstances of death. These practices vary worldwide according to the team approach and local population background.WHAT THIS STUDY ADDS: Although our population is mostly religious, we observed a decline in maximal intensive care along with increasing redirection of care over a decade. Changes in the team approach and increasing level of parental involvement influence type and duration of treatment.abstract OBJECTIVES: To follow changes in the causes of neonatal deaths in the NICU at Hadassah Medical Center, Jerusalem, Israel, over a decade; to examine trends regarding types of end-of-life-care provided (primary nonintervention, maximal intensive, and redirection of intensive care, including limitation of care and withdrawal of life-sustaining treatment); and to assess the parental role in the decision-making process given that the majority of the population is religious. METHODS:All neonates who died between 2000 and 2009 were identified. The causes and circumstances of death were abstracted from the medical records. Trends in end-of-life decisions were compared between 2 time periods:

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“…At many institutions, including ours, the practices and policies of withholding and withdrawing care have been studied and modified. [6][7][8][9][10] At LAC þ USC, 72% of deaths from 1993 to 2002 resulted from care not initiated or care withdrawn. 6 We believe that such intense interest with respect to infant quality of life has resulted in fewer postponed deaths in the postneonatal period.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, it was shown that while extreme prematurity made up 60% of cases in which care was not initiated at birth, congenital anomalies only made up 33% of the cases. 6 This may account for the increasing percentage of postneonatal deaths made up by congenital anomalies.…”

Section: Discussionmentioning

confidence: 99%

Decreasing trend in postneonatal mortality

2008

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Objective: The objective was to evaluate the postneonatal mortality rate at our institution from 1999 to 2006 as a follow-up to a previous report from our hospital covering 1993 to 1998 and to investigate the causes of death in infants dying in the postneonatal period.Study Design: We identified all infant deaths before discharge from the nursery aged X28 days. Clinical data for all cases and autopsy records where available were reviewed and the cause of death was determined for each infant.Result: Total nursery deaths for the 7 years were 211, of which 14 (6.6%) occurred after the neonatal period. This represents a decreasing trend from the 12% reported in 1993 to 1998. Causes of death were the complications of prematurity and congenital defects. The five infants whose cause of death was the complications of prematurity had chronic lung disease, four had abdominal surgery for perforation and resection and two had intraventricular hemorrhage (IVH) Gr IV. All infants had multiple organ failure by the time of death and the final event was infection and/or renal failure. The nine congenital defects included two trisomy 21 with complications, one CHARGE association with heart defects, one hypertrophic cardiomyopathy and two others with multiple congenital heart defects. Of the three remaining infants, the anomalies included one with hydranencephaly, one with caudal regression and one with multiple vascular liver tumors. Conclusion:Along with the general decrease in infant mortality, postneonatal mortality is decreasing as a percentage of nursery deaths. The causes of death include complications of prematurity and congenital defects.

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The Contribution of Withholding or Withdrawing Care to Newborn Mortality

Cited by 62 publications

References 6 publications

Risk Factors For Perinatal Mortality In Arua Regional Referral Hospital, West Nile, Uganda

Risk Factors For Perinatal Mortality In Arua Regional Referral Hospital, West Nile, Uganda

Neonatal End-of-Life Care: A Single-Center NICU Experience in Israel Over a Decade

Decreasing trend in postneonatal mortality

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