Journal article
Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates
Archives of disease in childhood. Fetal and neonatal edition, Vol.106(3), pp.238-243
05/2021
DOI: 10.1136/archdischild-2020-318855
PMCID: PMC8055718
PMID: 33082153
Abstract
ObjectiveTo identify sociodemographic and clinical factors associated with withholding or withdrawing life-sustaining treatment (WWLST) for extremely low gestational age neonates.DesignObservational study of prospectively collected registry data from 19 National Institute of Child Health and Human Development Neonatal Research Network centres on neonates born at 22–28 weeks gestation who died >12 hours through 120 days of age during 2011–2016. Sociodemographic and clinical factors were compared between infants who died following WWLST and without WWLST.ResultsOf 1168 deaths, 67.1% occurred following WWLST. Withdrawal of assisted ventilation (97.4%) was the primary modality. WWLST rates were inversely proportional to gestational age. Life-sustaining treatment was withheld or withdrawn more often for non-Hispanic white infants than for non-Hispanic black infants (72.7% vs 60.4%; 95% CI 1.00 to 1.92) or Hispanic infants (72.7% vs 67.2%; 95% CI 1.32 to 3.72). WWLST rates varied across centres (38.6–92.6%; p<0.001). The centre with the highest rate had adjusted odds 4.89 times greater than the average (95% CI 1.18 to 20.18). The adjusted odds of WWLST were higher for infants with necrotiing enterocolitis (OR 1.77, 95% CI 1.21 to 2.59) and severe brain injury (OR 1.98, 95% CI 1.44 to 2.74).ConclusionsAmong infants who died, WWLST rates varied widely across centres and were associated with gestational age, race, ethnicity, necrotiing enterocolitis, and severe brain injury. Further exploration is needed into how race, centre, and approaches to care of infants with necrotiing enterocolitis and severe brain injury influence WWLST.
Details
- Title: Subtitle
- Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates
- Creators
- April R Dworetz - Emory UniversityGirija Natarajan - Wayne State UniversityJohn Langer - RTI InternationalKathy Kinlaw - Emory UniversityJennifer R James - Division of NeonatologyMargarita Bidegain - Duke UniversityAbhik Das - RTI InternationalBrenda Poindexter - Cincinnati Children's Hospital Medical CenterEdward F Bell - University of IowaC M Cotten - Duke UniversityHaresh Kirpalani - Children's Hospital of PhiladelphiaSeetha Shankaran - Wayne State UniversityBarbara J Stoll - The University of Texas Health Science Center at HoustonEunice Kennedy Shriver Natl Inst C
- Resource Type
- Journal article
- Publication Details
- Archives of disease in childhood. Fetal and neonatal edition, Vol.106(3), pp.238-243
- DOI
- 10.1136/archdischild-2020-318855
- PMID
- 33082153
- PMCID
- PMC8055718
- NLM abbreviation
- Arch Dis Child Fetal Neonatal Ed
- ISSN
- 1359-2998
- eISSN
- 1468-2052
- Grant note
- DOI: 10.13039/100006108, name: the National Center for Advancing Translational Sciences, award: UL1 TR1425, UL1 TR1117, UL1 TR454, UL1 TR1108, UL1; name: The National Institutes of Health and Eunice Kennedy Shriver National Institute of Child Health and Human Development, award: (UG1 HD27904, UG1 HD21364, UG1 HD68284, UG1 HD2785
- Language
- English
- Date published
- 05/2021
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9984354156402771
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