Center, Gestational Age, and Race Impact End-of-Life Care Practices at Regional Neonatal Intensive Care Units
| Autor: | Eugenia K. Pallotto, Kevin M Sullivan, Ankur Datta, Amy B. Schlegel, Kristina M. Reber, Jacquelyn R. Evans, Francine D. Dykes, Nana Matoba, Robert DiGeronimo, Karna Murthy, Michael A. Padula, Carl H. Coghill, Anita R. Shah, Jessica T. Fry, Billie L. Short, Anthony J. Piazza, Thomas Bartman, Isabella Zaniletti, Beverly S. Brozanski, David J. Durand, Girija Natarajan, Steven R. Leuthner, Jason Z Niehaus, Jeanette M. Asselin, Theresa R. Grover |
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| Rok vydání: | 2020 |
| Předmět: |
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medicine.medical_specialty Databases Factual medicine.medical_treatment Gestational Age Infant Newborn Diseases 03 medical and health sciences 0302 clinical medicine Cause of Death Intensive Care Units Neonatal 030225 pediatrics Intensive care Ethnicity medicine Humans 030212 general & internal medicine Cardiopulmonary resuscitation Resuscitation Orders Retrospective Studies Cause of death Patient factors Terminal Care Asian business.industry Infant Newborn Gestational age Retrospective cohort study Hospitals Pediatric Cardiopulmonary Resuscitation United States Black or African American Multivariate Analysis Pediatrics Perinatology and Child Health Cohort Emergency medicine Intensive Care Neonatal Female business End-of-life care |
| Zdroj: | The Journal of Pediatrics. 217:86-91.e1 |
| ISSN: | 0022-3476 |
| Popis: | To assess the impact of intercenter variation and patient factors on end-of-life care practices for infants who die in regional neonatal intensive care units (NICUs).We conducted a retrospective cohort analysis using the Children's Hospital Neonatal Database during 2010-2016. A total of 6299 nonsurviving infants cared for in 32 participating regional NICUs were included to examine intercenter variation and the effects of gestational age, race, and cause of death on 3 end-of-life care practices: do not attempt resuscitation orders (DNR), cardiopulmonary resuscitation within 6 hours of death (CPR), and withdrawal of life-sustaining therapies (WLST). Factors associated with these practices were used to develop a multivariable equation.Dying infants in the cohort underwent DNR (55%), CPR (21%), and WLST (73%). Gestational age, cause of death, and race were significantly and differently associated with each practice: younger gestational age (28 weeks) was associated with CPR (OR 1.7, 95% CI 1.5-2.1) but not with DNR or WLST, and central nervous system injury was associated with DNR (1.6, 1.3-1.9) and WLST (4.8, 3.7-6.2). Black race was associated with decreased odds of WLST (0.7, 0.6-0.8). Between centers, practices varied widely at different gestational ages, race, and causes of death.From the available data on end-of-life care practices for regional NICU patients, variability appears to be either individualized or without consistency. |
| Databáze: | OpenAIRE |
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