Journal article
Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support
The Journal of pediatrics, Vol.190, pp.118-123.e4
11/2017
DOI: 10.1016/j.jpeds.2017.05.056
PMCID: PMC5690862
PMID: 28647272
Abstract
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.
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.
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.
Wide center variations in WWLST discussions occur, especially at ≤24 weeks GA. Outcomes of infants surviving after WWLST discussions are poor.
ClinicalTrials.gov: NCT00063063.
Details
- Title: Subtitle
- Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support
- Creators
- Angelita M. Hensman - Brown UniversityElisa Vieira - Brown UniversityEmilee Little - Brown UniversityRobert Burke - Brown UniversityMelinda Caskey - Brown UniversityKatharine Johnson - Brown UniversityBarbara Alksninis - Brown UniversityMary Lenore Keszler - Brown UniversityAndrea M. Knoll - Brown UniversityTheresa M. Leach - Brown UniversityElisabeth C. McGowan - Brown UniversityVictoria E. Watson - Brown UniversitySuzy Ventura - Brown UniversityMichele C. Walsh - Case Western Reserve UniversityAvroy A. Fanaroff - Case Western Reserve UniversityAnna Marie Hibbs - Case Western Reserve UniversityNancy S. Newman - Case Western Reserve UniversityAllison H. Payne - Case Western Reserve UniversityDeanne E. Wilson-Costello - Case Western Reserve UniversityBonnie S. Siner - Case Western Reserve UniversityMonika Bhola - Case Western Reserve UniversityGulgun Yalcinkaya - Case Western Reserve UniversityHarriet G. Friedman - Case Western Reserve UniversityWilliam E. Truog - University of Missouri–Kansas CityEugenia K. Pallotto - University of Missouri–Kansas CityHoward W. Kilbride - University of Missouri–Kansas CityCheri Gauldin - University of Missouri–Kansas CityAnne Holmes - University of Missouri–Kansas CityKathy Johnson - University of Missouri–Kansas CityAllison Knutson - University of Missouri–Kansas CityKurt Schibler - Cincinnati Children's Hospital Medical Center, University Hospital, Good Samaritan HospitalBarbara Alexander - Cincinnati Children's Hospital Medical Center, University Hospital, Good Samaritan HospitalCathy Grisby - Cincinnati Children's Hospital Medical Center, University Hospital, Good Samaritan HospitalTeresa L. Gratton - Cincinnati Children's Hospital Medical Center, University Hospital, Good Samaritan HospitalJean J. Steichen - Cincinnati Children's Hospital Medical Center, University Hospital, Good Samaritan HospitalEstelle E. Fischer - Cincinnati Children's Hospital Medical Center, University Hospital, Good Samaritan HospitalLenora Jackson - Cincinnati Children's Hospital Medical Center, University Hospital, Good Samaritan HospitalKristin Kirker - Cincinnati Children's Hospital Medical Center, University Hospital, Good Samaritan HospitalGreg Muthig - Cincinnati Children's Hospital Medical Center, University Hospital, Good Samaritan HospitalStacey Tepe - Cincinnati Children's Hospital Medical Center, University Hospital, Good Samaritan HospitalKimberly Yolton - Cincinnati Children's Hospital Medical Center, University Hospital, Good Samaritan HospitalRonald N. Goldberg - Duke University School of MedicineC. Michael Cotten - Duke University School of MedicineRicki F. Goldstein - Duke University School of MedicineWilliam F. Malcolm - Duke University School of MedicinePatricia L. Ashley - Duke University School of MedicineKimberley A. Fisher - Duke University School of MedicineJoanne Finkle - Duke University School of MedicineKathryn E. Gustafson - Duke University School of MedicineMatthew M. Laughon - Duke University School of MedicineCarl L. Bose - Duke University School of MedicineJanice Bernhardt - Duke University School of MedicineGennie Bose - Duke University School of MedicineJanice Wereszczak - Duke University School of MedicineDavid P. Carlton - Emory University Hospital MidtownEllen C. Hale - Emory University Hospital MidtownIra Adams-Chapman - Emory University Hospital MidtownYvonne Loggins - Emory University Hospital MidtownStephanie Wilson Archer - Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentGregory M. Sokol - Indiana UniversityLu-Ann Papile - Indiana UniversityLeslie Dawn Wilson - Indiana UniversityDianne E. Herron - Indiana UniversitySusan Gunn - Indiana UniversityLucy Smiley - Indiana UniversityAbbey C. Hines - Indiana UniversityLeif D. Nelin - The Ohio State University Wexner Medical CenterSudarshan R. Jadcherla - The Ohio State University Wexner Medical CenterPablo J. Sánchez - The Ohio State University Wexner Medical CenterPatricia Luzader - The Ohio State University Wexner Medical CenterGail E. Besner - The Ohio State University Wexner Medical CenterNehal A. Parikh - The Ohio State University Wexner Medical CenterDennis Wallace - RTI InternationalMarie G. Gantz - RTI InternationalJamie E. Newman - RTI InternationalJeanette O'Donnell Auman - RTI InternationalMargaret Crawford - RTI InternationalCarolyn M. Petrie Huitema - RTI InternationalKristin M. Zaterka-Baxter - RTI InternationalKrisa P. Van Meurs - Stanford UniversityDavid K. Stevenson - Stanford UniversityM. Bethany Ball - Stanford UniversitySusan R. Hintz - Stanford UniversityMelinda S. Proud - Stanford UniversityBarbara Bentley - Stanford UniversityMaria Elena DeAnda - Stanford UniversityAnne M. DeBattista - Stanford UniversityBeth Earhart - Stanford UniversityLynne C. Huffman - Stanford UniversityCasey E. Krueger - Stanford UniversityHali E. Weiss - Stanford UniversityWaldemar A. Carlo - University of Alabama at BirminghamNamasivayam Ambalavanan - University of Alabama at BirminghamMyriam Peralta-Carcelen - University of Alabama at BirminghamMonica V. Collins - University of Alabama at BirminghamShirley S. Cosby - University of Alabama at BirminghamFred J. Biasini - University of Alabama at BirminghamKristen C. Johnston - University of Alabama at BirminghamCryshelle S. Patterson - University of Alabama at BirminghamVivien A. Phillips - University of Alabama at BirminghamSally Whitley - University of Alabama at BirminghamUday Devaskar - University of California, Los AngelesMeena Garg - University of California, Los AngelesIsabell B. Purdy - University of California, Los AngelesTeresa Chanlaw - University of California, Los AngelesRachel Geller - University of California, Los AngelesDan L. Ellsbury - University of IowaTarah T. Colaizy - University of IowaJane E. Brumbaugh - University of IowaJohn A. Widness - University of IowaKaren J. Johnson - University of IowaJacky R. Walker - University of IowaDonia B. Campbell - University of IowaDiane L. Eastman - University of Iowa and Mercy Medical CenterKristi L. Watterberg - University of New MexicoJean R. Lowe - University of New MexicoJanell F. Fuller - University of New Mexico Health Sciences CenterRobin K. Ohls - University of New MexicoConra Backstrom Lacy - University of New MexicoJennifer James - Children's Hospital of PhiladelphiaAndrea F. Duncan - University of New Mexico Health Sciences CenterDavid Munson - Children's Hospital of PhiladelphiaBarbara Schmidt - Hospital of the University of PennsylvaniaSara B. DeMauro - Children's Hospital of PhiladelphiaAasma S. Chaudhary - Hospital of the University of PennsylvaniaJohn C. Langer - RTI InternationalSoraya Abbasi - Hospital of the University of PennsylvaniaApril R. Dworetz - Children's Healthcare of AtlantaToni Mancini - Hospital of the University of PennsylvaniaJudy C. Bernbaum - Hospital of the University of PennsylvaniaGirija Natarajan - Wayne State UniversityMargarita Bidegain - Duke UniversityMarsha Gerdes - Hospital of the University of PennsylvaniaChristine A. Fortney - Nationwide Children's HospitalHallam Hurt - Hospital of the University of PennsylvaniaRuth Seabrook - Nationwide Children's HospitalCarl T. D'Angio - University of Rochester Medical CenterBetty R. Vohr - Women & Infants Hospital of Rhode IslandRonnie Guillet - University of Rochester Medical CenterJon E. Tyson - Department of Pediatrics, University of Texas Medical School at Houston, Houston, TXSatyan Lakshminrusimha - University of Rochester Medical CenterEdward F. Bell - University of IowaAnne Marie Reynolds - University of Rochester Medical CenterBrenda B. Poindexter - Cincinnati Children's Hospital Medical CenterRosemary L. Jensen - University of Rochester Medical CenterSeetha Shankaran - Wayne State UniversityJoan Merzbach - University of Rochester Medical CenterGary J. Myers - University of Rochester Medical CenterRosemary D. Higgins - Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentAshley Williams - University of Rochester Medical CenterAbhik Das - RTI InternationalBarbara J. Stoll - Children's Healthcare of AtlantaKelley Yost - University of Rochester Medical CenterHaresh Kirpalani - Children's Hospital of PhiladelphiaWilliam Zorn - University of Rochester Medical CenterKaren Wynn - University of Rochester Medical CenterMichael S. Caplan - University of ChicagoDeanna Maffett - University of Rochester Medical CenterAbbot R. Laptook - Brown UniversityDiane Prinzing - University of Rochester Medical CenterJulianne Hunn - University of Rochester Medical CenterStephanie Guilford - University of Rochester Medical CenterFarooq Osman - University of Rochester Medical CenterMary Rowan - University of Rochester Medical CenterMichael G. Sacilowski - University of Rochester Medical CenterHolly I.M. Wadkins - University of Rochester Medical CenterMelissa Bowman - University of Rochester Medical CenterKathleen A. Kennedy - The University of Texas Health Science Center at HoustonJulie Arldt-McAlister - The University of Texas Health Science Center at HoustonKatrina Burson - The University of Texas Health Science Center at HoustonAndrea Freeman Duncan - The University of Texas Health Science Center at HoustonCarmen Garcia - The University of Texas Health Science Center at HoustonBeverly Foley Harris - The University of Texas Health Science Center at HoustonJanice John - The University of Texas Health Science Center at HoustonPatrick M. Jones - The University of Texas Health Science Center at HoustonLayne M. Lillie - The University of Texas Health Science Center at HoustonKaren Martin - The University of Texas Health Science Center at HoustonSara C. Martin - The University of Texas Health Science Center at HoustonGeorgia E. McDavid - The University of Texas Health Science Center at HoustonShawna Rodgers - The University of Texas Health Science Center at HoustonSaba Siddiki - The University of Texas Health Science Center at HoustonDaniel Sperry - The University of Texas Health Science Center at HoustonPatti L. Pierce Tate - The University of Texas Health Science Center at HoustonSharon L. Wright - The University of Texas Health Science Center at HoustonMyra Wyckoff - The University of Texas Southwestern Medical CenterLuc P. Brion - The University of Texas Southwestern Medical CenterDiana M. Vasil - The University of Texas Southwestern Medical CenterLijun Chen - The University of Texas Southwestern Medical CenterRoy J. Heyne - The University of Texas Southwestern Medical CenterSally S. Adams - The University of Texas Southwestern Medical CenterLinda A. Madden - The University of Texas Southwestern Medical CenterElizabeth Heyne - The University of Texas Southwestern Medical CenterAlicia Guzman - The University of Texas Southwestern Medical CenterLizette E. Torres - The University of Texas Southwestern Medical CenterCatherine Twell Boatman - The University of Texas Southwestern Medical CenterAthina Pappas - Wayne State UniversityRebecca Bara - Wayne State UniversityLaura A. Goldston - Wayne State UniversityJohn Barks - Wayne State UniversityMary Christensen - Wayne State UniversityStephanie Wiggins - Wayne State UniversityDiane White - Wayne State UniversityNational Institute of Child Health and Human Development Neonatal Research Network
- Resource Type
- Journal article
- Publication Details
- The Journal of pediatrics, Vol.190, pp.118-123.e4
- DOI
- 10.1016/j.jpeds.2017.05.056
- PMID
- 28647272
- PMCID
- PMC5690862
- NLM abbreviation
- J Pediatr
- ISSN
- 0022-3476
- eISSN
- 1097-6833
- Publisher
- Elsevier Inc
- Grant note
- National Center for Research Resources (http://dx.doi.org/10.13039/100000097) National Institute of Child Health and Human Development (http://dx.doi.org/10.13039/100000071) National Center for Advancing Translational Sciences (http://dx.doi.org/10.13039/100006108) 2UG1HD068244 / National Institutes of Health (http://dx.doi.org/10.13039/100000002)
- Language
- English
- Date published
- 11/2017
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984353833402771
Metrics
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