End-of-life decisions in Dutch neonatal intensive care units.
OBJECTIVE
To clarify the practice of end-of-life decision making in severely ill newborns.


METHODS
Retrospective descriptive study with face-to-face interviews.


METHODS
The 10 neonatal intensive care units in the Netherlands from October 2005 to September 2006.


METHODS
All 367 newborn infants who died in the first 2 months of life in Dutch neonatal intensive care units. Adequate documentation was available in 359 deaths.


METHODS
Presence of end-of-life decisions, classification of deaths in 3 groups, and physicians' considerations leading to end-of-life decisions.


RESULTS
An end-of-life decision preceded death in 95% of cases, and in 5% treatment was continued until death. Of all of the deaths, 58% were classified as having no chance of survival and 42% were stabilized newborns with poor prognoses. Withdrawal of life-sustaining therapy was the main mode of death in both groups. One case of deliberate ending of life was found. In 92% of newborns with poor prognoses, end-of-life decisions were based on patients' future quality of life and mainly concerned future suffering. Considerations regarding the infant's present state were made in 44% of infants.


CONCLUSIONS
Virtually all deaths in Dutch neonatal intensive care units are preceded by the decision to withdraw life-sustaining treatment and many decisions are based on future quality of life. The decision to deliberately end the life of a newborn may occur less frequently than was previously assumed.
Verhagen
A A Eduard
AA
Department of Pediatrics, University Medical Centre, 9700 RB Groningen, the Netherlands. e.verhagen@bkk.umcg.nl
Dorscheidt
Jozef H H M
JH
Engels
Bernadette
B
Hubben
Joep H
JH
Sauer
Pieter J
PJ
D002423:Cause of Death; D003657:Decision Making; D005065:Euthanasia; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000628:therapy*; D007363:Intensive Care Units, Neonatal; D008297:Male; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D028761:Withholding Treatment