Medical Futility Trend Seen in Neonatal Deaths07/05/11
TUESDAY, July 5 (HealthDay News) -- 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
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
"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
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