A descriptive report of end-of-life care practices occurring in two neonatal intensive care units
| Autor: | Chloe Joynt, Michael van Manen, Nicole Kain, Vanessa Lam |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Canada
Pediatrics medicine.medical_specialty Neonatal intensive care unit Palliative care Hypoxic Ischemic Encephalopathy Cohort Studies 03 medical and health sciences 0302 clinical medicine Cause of Death Intensive Care Units Neonatal 030225 pediatrics Intensive care medicine Humans 030212 general & internal medicine Retrospective Studies Terminal Care business.industry Infant Newborn General Medicine Infant mortality Intensive Care Units Anesthesiology and Pain Medicine Withholding Treatment Cohort Quality of Life business Developed country End-of-life care |
| Zdroj: | Palliative Medicine. 30:971-978 |
| ISSN: | 1477-030X 0269-2163 |
| DOI: | 10.1177/0269216316634246 |
| Popis: | Background: In Canada and other developed countries, the majority of neonatal deaths occur in tertiary neonatal intensive care units. Most deaths occur following the withdrawal of life-sustaining treatments. Aim: To explore neonatal death events and end-of-life care practices in two tertiary neonatal intensive care settings. Design: A structured, retrospective, cohort study. Setting/participants: All infants who died under tertiary neonatal intensive care from January 2009 to December 2013 in a regional Canadian neonatal program. Deaths occurring outside the neonatal intensive care unit in delivery rooms, hospital wards, or family homes were not included. Overall, 227 infant deaths were identified. Results: The most common reasons for admission included prematurity (53.7%), prematurity with congenital anomaly/syndrome (20.3%), term congenital anomaly (11.5%), and hypoxic ischemic encephalopathy (12.3%). The median age at death was 7 days. Death tended to follow a decision to withdraw life-sustaining treatment with anticipated poor developmental outcome or perceived quality of life, or in the context of a moribund dying infant. Time to death after withdrawal of life-sustaining treatment was uncommonly a protracted event but did vary widely. Most dying infants were held by family members in the neonatal intensive care unit or in a parent room off cardiorespiratory monitors. Analgesic and sedative medications were variably given and not associated with a hastening of death. Conclusion: Variability exists in end-of-life care practices such as provision of analgesic and sedative medications. Other practices such as discontinuation of cardiorespiratory monitors and use of parent rooms are more uniform. More research is needed to understand variation in neonatal end-of-life care. |
| Databáze: | OpenAIRE |
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