title: End of life, death and dying in neonatal intensive care units in Latin America.
abstract: OBJECTIVE
  Most analyses of end of life decisions in Neonatal Intensive Care Units (NICUs) have come from Europe/English-speaking countries. Would decisions be different in Latin American NICUs? Therefore, we aim to evaluate the approach to dying infants/families in NICUs in Latin America.
  
  
  METHODS
  Multinational descriptive study of all deaths in babies born at >22 weeks in eight NICUs in five Latin American countries. Deaths were categorized as: (i) no Cardiopulmonary Resuscitation (CPR) or life support offered; (ii) life support initiated but do not resuscitate (DNR) orders written or no CPR provided; (iii) full life support and CPR; and (iv) unclassifiable.
  
  
  RESULTS
  There were 100 deaths, 81% in >27 weeks. Seventeen infants received no CPR/life support at birth, 10 died in DR and seven in NICU. There were 27 infants in group 2, 54 in group three and two in group 4. No baby had care withdrawn or care withdrawn/CPR withheld. Thirty-two infants had 'do not resuscitate' order. Decisions without parents' involvement in 15%, both parents present at death 24% and sedatives/narcotics documented 14%.
  
  
  CONCLUSIONS
  Latin American NICUs differ from those in Northern Europe/English-speaking countries. More deaths are accompanied by full life support and CPR. DNR orders are rare. Withdrawal of life support is virtually non-existent. Latin American's doctors are more likely to make decisions without the objections of family about withholding life-sustaining treatment.
authors.affiliation: University of Calgary, Alberta, Canada. carlos.fajardo@albertahealthservices.ca
authors.forename: C A
authors.initials: CA
authors.lastname: Fajardo
authors.forename: S
authors.initials: S
authors.lastname: González
authors.forename: G
authors.initials: G
authors.lastname: Zambosco
authors.forename: M J
authors.initials: MJ
authors.lastname: Cancela
authors.forename: L V
authors.initials: LV
authors.lastname: Forero
authors.forename: M
authors.initials: M
authors.lastname: Venegas
authors.forename: H
authors.initials: H
authors.lastname: Baquero
authors.forename: L
authors.initials: L
authors.lastname: Lemus-Varela
authors.forename: J
authors.initials: J
authors.lastname: Kattan
authors.forename: F
authors.initials: F
authors.lastname: Wormald
authors.forename: A
authors.initials: A
authors.lastname: Sola
authors.forename: J
authors.initials: J
authors.lastname: Lantos
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007843:Latin America; D008020:Life Support Care / Q000706:statistics & numerical data*; D008297:Male; D016414:Resuscitation Orders; D028761:Withholding Treatment / Q000706:statistics & numerical data*