title: Dutch neonatologists have adopted a more interventionist approach to neonatal care.
abstract: OBJECTIVE
  This study investigated whether continuous improvements to neonatal care and the legalisation of newborn euthanasia in 2005 had changed end-of-life decisions by Dutch neonatologists.
  
  
  METHODS
  We carried out a retrospective study of foetuses and neonates of more than 22 weeks' gestation that died in the delivery room or in the neonatal intensive care unit (NICU) of a tertiary referral hospital in the Netherlands, comparing end-of-life decisions and mortality in 2001-2003 and 2008-2010, before and after euthanasia legislation was introduced.
  
  
  RESULTS
  In 2008-2010, there were more deaths in the delivery room due to termination of pregnancy than in 2001-2003 (17% versus 29%, p = 0.031), and fewer infants received comfort medication (12% versus 20%, p = 0.078). The main mode of death in the NICU was the withdrawal of life-sustaining therapy. The number of days that infants lived increased significantly between 2001-2003 (11.5 days) and 2008-2010 (18.4 days, p < 0.006). Most infants received comfort medication, and neuromuscular blocking agents were administered incidentally.
  
  
  CONCLUSIONS
  Terminations increased after changes in healthcare regulations. Modes of death in the NICU remained similar over 10 years. The increased duration of NICU treatment before dying suggests a more interventionist approach to treatment in 2008-2010.
authors.affiliation: Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Jan F
authors.initials: JF
authors.lastname: Koper
authors.affiliation: Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: Arend F
authors.initials: AF
authors.lastname: Bos
authors.affiliation: Division of Neonatology and Clinical Ethics, Sainte-Justine Hospital, University of Montreal, Montreal, QC, Canada.
authors.forename: Annie
authors.initials: A
authors.lastname: Janvier
authors.affiliation: Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
authors.forename: A A Eduard
authors.initials: AA
authors.lastname: Verhagen
mesh_terms: D005065:Euthanasia / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000401:mortality* / Q000628:therapy*; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D008297:Male; D009359:Neonatology; D009426:Netherlands; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D028761:Withholding Treatment
keywords: Delivery room; End-of-life decisions; Ethics; Modes of death; Neonatal intensive care unit