title: How infants die in the neonatal intensive care unit: trends from 1999 through 2008.
abstract: OBJECTIVE
  To determine whether trends toward decreasing use of cardiopulmonary resuscitation at the time of death and increasing frequency of forgoing life-sustaining treatment had continued, as few studies quantifying mode of death for hospitalized infants have been conducted in the last 10 years.
  
  
  METHODS
  Retrospective descriptive study.
  
  
  METHODS
  Regional referral neonatal intensive care unit.
  
  
  METHODS
  Infants who died from January 1, 1999, to December 31, 2008. Infants were categorized into following categories: (1) very preterm (≤32 weeks' gestation); (2) congenital anomaly; and (3) other.
  
  
  METHODS
  The primary outcome was level of clinical service provided at the end of life (care withheld, care withdrawn, or full resuscitation).
  
  
  RESULTS
  For 10 years, 414 neonatal patients died. Of these, 61.6% had care withdrawn, 20.8% had care withheld, and 17.6% received cardiopulmonary resuscitation. The percentage of deaths that followed withholding of treatment rose by 1% per year (P = .01). Most of this change was accounted for by withholding of therapy in the very premature group.
  
  
  CONCLUSIONS
  During the 10-year period, the primary mode of death in this regional referral neonatal intensive care unit was withdrawal of life-sustaining support. When death is imminent or medical care is considered futile, the approach is thought to provide a peaceful, controlled setting. Significant increase in withholding of care suggests improved recognition of medical futility and desire to provide a peaceful death.
authors: Department of Neonatology, Children's Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, MO 64119, USA. jweiner@cmh.edu
authors: Julie
authors: J
authors: Weiner
authors: Jotishna
authors: J
authors: Sharma
authors: John
authors: J
authors: Lantos
authors: Howard
authors: H
authors: Kilbride
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D002423:Cause of Death; D016009:Chi-Square Distribution; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D016014:Linear Models; D008297:Male; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D028761:Withholding Treatment