Restriction of ongoing intensive care in neonates: a prospective study.
OBJECTIVE
The purpose of this work was to record the current practice of restricting ongoing intensive care in severely ill newborns.


METHODS
This was a prospective observational study over a 30-month period of consecutive newborns for whom restriction of ongoing intensive care was taken into consideration, discussed, or decided on. A standardized form recorded patients' medical condition, the type of restriction decided on, parents' wishes, and their information level. The research was conducted in a neonatal unit of a level III university children's hospital, with no interventions.


RESULTS
Forty patients were enrolled, 25 were preterm, 21 had either a genetic defect or an inborn malformation. Restriction of ongoing intensive care was decided on for 32 patients with a great variety of specified recommendations. Thirty-six patients died during the observation period. In general, parents were well informed; however, their wishes concerning restriction of ongoing intensive care were unknown in approximately 25% of cases.


CONCLUSIONS
The decision-making process for restriction of ongoing intensive care is well established, but the role of parents needs to be defined.
Hentschel
Roland
R
Department of Pediatrics and Adolescent Medicine, Division of Neonatology, University of Freiburg, Mathildenstrasse 1, 79106 Freiburg, Germany. roland.hentschel@uniklinik-freiburg.de
Lindner
Katharina
K
Krueger
Markus
M
Reiter-Theil
Stella
S
D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000628:therapy*; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000628:therapy*; D003657:Decision Making; D028741:Ethics Committees, Clinical; D030342:Genetic Diseases, Inborn / Q000453:epidemiology / Q000628:therapy*; D005858:Germany / Q000453:epidemiology; D005865:Gestational Age; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000453:epidemiology / Q000628:therapy; D015931:Intensive Care, Neonatal / Q000941:ethics / Q000706:statistics & numerical data; D018447:Medical Futility; D010290:Parents / Q000523:psychology; D010351:Patient Discharge; D010820:Physicians / Q000523:psychology; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D016079:Refusal to Treat / Q000941:ethics / Q000706:statistics & numerical data