title: Does diagnosis influence end-of-life decisions in the neonatal intensive care unit?
abstract: OBJECTIVE
  To determine the influence of physiological status and diagnosis at the time of death on end-of-life care.
  
  
  METHODS
  Retrospective descriptive study in a regional referral level IV neonatal intensive care unit (NICU) of infants who died from 1 January 1999 to 31 December 2008. Infants were categorized based on diagnosis (very preterm, congenital anomalies or other) and level of stability. Primary outcome was level of clinical service provided at end of life (care withheld, care withdrawn or full resuscitation).
  
  
  RESULTS
  From 1999 to 2008, there were 414 deaths in the NICU. Congenital anomaly was the leading diagnosis at the time of death, representing 45% of all deaths. Comparing mode of death, very preterm newborns were more likely than infants with congenital anomalies to have received cardio-pulmonary resuscitation (CPR) at the time of death (26% vs 13%, P < 0.01) and were significantly more unstable (75% vs 52%, P < 0.01). Infants aged 22 to 24 weeks were mostly unstable and significantly more likely to receive CPR than infants with any other diagnosis.
  
  
  CONCLUSIONS
  Over the 10-year period, very preterm infants were more likely to be physiologically unstable and to receive CPR at the time of death than infants with any other diagnosis. This finding was especially true for infants at the edge of viability (22 to 24 weeks). These differences in end-of-life care suggest that the quality of life and medical futility may be viewed differently for the least mature infants.
authors.affiliation: Division of Neonatology, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City, School of Medicine, Kansas, MO, USA.
authors.forename: J
authors.initials: J
authors.lastname: Weiner
authors.affiliation: Division of Neonatology, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City, School of Medicine, Kansas, MO, USA.
authors.forename: J
authors.initials: J
authors.lastname: Sharma
authors.affiliation: Department of Pediatrics, Children's Mercy Hospitals and Clinics Bioethics Center, University of Missouri-Kansas City, School of Medicine, Kansas, MO, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lantos
authors.affiliation: Division of Neonatology, Children's Mercy Hospitals and Clinics, University of Missouri-Kansas City, School of Medicine, Kansas, MO, USA.
authors.forename: H
authors.initials: H
authors.lastname: Kilbride
mesh_terms: D001293:Attitude to Death; D016887:Cardiopulmonary Resuscitation / Q000523:psychology; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000523:psychology; D003657:Decision Making; D003933:Diagnosis; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature / Q000523:psychology*; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D015931:Intensive Care, Neonatal / Q000379:methods / Q000523:psychology; D008297:Male; D018447:Medical Futility / Q000523:psychology*; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013727:Terminal Care / Q000523:psychology*