title: Neonatal end-of-life care: a single-center NICU experience in Israel over a decade.
abstract: OBJECTIVE
  To follow changes in the causes of neonatal deaths in the NICU at Hadassah Medical Center, Jerusalem, Israel, over a decade; to examine trends regarding types of end-of-life-care provided (primary nonintervention, maximal intensive, and redirection of intensive care, including limitation of care and withdrawal of life-sustaining treatment); and to assess the parental role in the decision-making process given that the majority of the population is religious.
  
  
  METHODS
  All neonates who died between 2000 and 2009 were identified. The causes and circumstances of death were abstracted from the medical records. Trends in end-of-life decisions were compared between 2 time periods: 2000-2004 versus 2005-2009.
  
  
  RESULTS
  Overall, 239 neonates died. The leading cause of death in both study periods was prematurity and its complications (76%). Among term infants, the leading cause of death was congenital anomalies (48%). Fifty-six percent of the infants received maximal intensive care; 28% had redirection of intensive care, of whom 10% had withdrawal of life-sustaining treatment; and 16% had primary nonintervention care. Over the years, maximal intensive care decreased from 65% to 46% (P < .02), whereas redirection of care increased from 19.2% to 37.5% (P < .0005). An active parental role in the end-of-life decision process increased from 38% to 84%.
  
  
  CONCLUSIONS
  Even among religious families of extremely sick neonates, redirection of care is a feasible treatment option, suggesting that apart from survival, quality-of-life considerations emerge as an important factor in the decision-making process for the infant, parents, and caregivers.
authors.affiliation: Department of Neonatology, Hadassah and Hebrew University Medical Centers, Jerusalem, Israel. smadaref@hadassah.org.il
authors.forename: Smadar
authors.initials: S
authors.lastname: Eventov-Friedman
authors.forename: Hana
authors.initials: H
authors.lastname: Kanevsky
authors.forename: Benjamin
authors.initials: B
authors.lastname: Bar-Oz
mesh_terms: D002423:Cause of Death / Q000639:trends*; D003657:Decision Making; D005260:Female; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007557:Israel; D008297:Male; D010290:Parents; D013727:Terminal Care / Q000706:statistics & numerical data*
keywords: NICU; cause of death/trends; decision making; end-of-life care; infant mortality; life-sustaining treatment; neonatal death; parents; withholding treatment