title: Whom are we comforting? An analysis of comfort medications delivered to dying neonates.
abstract: OBJECTIVE
  To clarify the use of end-of-life comfort medications or neuromuscular blockers (NMBs) in culturally different neonatal intensive care units (NICUs).
  
  
  METHODS
  Review of medical files of newborns > 22 weeks gestation who died in the delivery room or the NICU during 12 months in four NICUs (Chicago, Milwaukee, Montreal, and Groningen). We compared use of end-of-life comfort medications and NMBs.
  
  
  RESULTS
  None of the babies who died in the delivery room received comfort medications. The use of opiods (77%) or benzodiazepines (41%) around death was similar in all NICUs. Increasing this medication around extubation occurred most often in Montreal, rarely in Milwaukee and Groningen, and never in Chicago. Comfort medications use had no significant impact on the time between extubation and death. NMBs were never used around death in Chicago, once in Montreal, and more frequently in Milwaukee and Groningen. Initiation of NMB after extubation occurred only in Groningen.
  
  
  CONCLUSIONS
  Comfort medications were administered to almost all dying infants in each NICU. Some, but not all, centers were comfortable increasing these medications around or after extubation. In three centers, NMBs were at times present at the time of death. However, only in Holland were NMBs initiated after extubation.
authors.affiliation: Pediatrics and Clinical Ethics, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Janvier
authors.forename: William
authors.initials: W
authors.lastname: Meadow
authors.forename: Steven R
authors.initials: SR
authors.lastname: Leuthner
authors.forename: Bree
authors.initials: B
authors.lastname: Andrews
authors.forename: Joanne
authors.initials: J
authors.lastname: Lagatta
authors.forename: Arend
authors.initials: A
authors.lastname: Bos
authors.forename: Laura
authors.initials: L
authors.lastname: Lane
authors.forename: A A Eduard
authors.initials: AA
authors.lastname: Verhagen
mesh_terms: D000700:Analgesics / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003657:Decision Making / Q000941:ethics*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D018447:Medical Futility; D009466:Neuromuscular Blocking Agents / Q000008:administration & dosage*; D010146:Pain / Q000188:drug therapy; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000188:drug therapy
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives; D009466:Neuromuscular Blocking Agents