title: Later rather than sooner: the impact of clinical management on timing and modes of death in the last decade.
abstract: OBJECTIVE
  Technological and clinical advances have reduced neonatal deaths, and this study explored how the mode and timing of neonatal deaths has changed in a tertiary neonatal intensive care unit (NICU) over 10 years.
  
  
  METHODS
  We carried out a retrospective chart review on NICU deaths in 2000-2002 and 2007-2010, categorising deaths and compared the timing, cause and mode of death in the two cohorts.
  
  
  RESULTS
  We analysed 204 neonatal deaths and found that the average age at death doubled from 9.71 days in 2000-2002 to 18.8 days (p = 0.014) in 2007-2010 and that the number of deaths in the first 48 h of life fell from 52% to 29% (p < 0.001). Mode of death and ethical decision-making was similar. In both cohorts, 26% of patients who died had a do not resuscitate order and 9% of the 151 patients without an order died while receiving cardiopulmonary resuscitation. Most neonates received medication to keep them comfortable and their use was similar in both cohorts.
  
  
  CONCLUSIONS
  Changes in neonatal management have led to a reduction in early deaths and an increase in age at death. The impact of later deaths on families and healthcare providers deserves further research.
authors.affiliation: Neonatology and Clinical Ethics, Université de Montréal, Sainte-Justine Hospital, Montreal, QC, Canada.
authors.forename: Amélie
authors.initials: A
authors.lastname: Dupont-Thibodeau
authors.affiliation: Neonatology and Clinical Ethics, Université de Montréal, Sainte-Justine Hospital, Montreal, QC, Canada.
authors.forename: Rosalie
authors.initials: R
authors.lastname: Langevin
authors.affiliation: Neonatology and Clinical Ethics, Université de Montréal, Sainte-Justine Hospital, Montreal, QC, Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Janvier
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000401:mortality*; D007363:Intensive Care Units, Neonatal; D008297:Male; D012189:Retrospective Studies; D013727:Terminal Care / Q000592:standards*; D013997:Time Factors
keywords: End-of-life care; Ethics; Modes of death; Neonatal intensive care unit; Palliative care