title: Delivery room deaths of extremely preterm babies: an observational study.
abstract: OBJECTIVE
  Many extremely preterm neonates die in the delivery room (DR) after decisions to withhold or withdraw life-sustaining treatments or after failed resuscitation. Specific palliative care is then recommended but sparse data exist about the actual management of these dying babies. The objective of this study was to describe the clinical course and management of neonates born between 22 and 26 weeks of gestation who died in the DR in France.
  
  
  METHODS
  Prospective study including neonates, who were liveborn between 22+0and 26+6weeks of gestation and died in the DR in 2011, among infants included in the EPIPAGE-2 study at the 18 centres participating in this substudy of extremely preterm neonates. Data were collected by a questionnaire completed by the professional caring for each baby.
  
  
  RESULTS
  The study included 73 children, with a median (IQR) gestational age of 24 (23-24) weeks. Median (IQR) duration of life was 53 (20-82) min. All but one were both wrapped and warmed. Pain was assessed for 72%, although without using any scale. Gasping was described for 66%. Comfort medications were administered to 35 children (50%), significantly more frequently to babies with gasping (p=0.001). Mother-child contact was reported for 78%, and psychological support offered to parents of 92%.
  
  
  CONCLUSIONS
  Non-pharmacological comfort care and parental support were routinely given. Comfort medication was given much more frequently than previously reported in other DRs. These data should encourage work on the indications for comfort medication and the interpretation of gasping.
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.|Service de Médecine Néonatale, Centre Hospitalier Intercommunal de Creteil, Clinical Research Center CHI Créteil, Créteil, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Durrmeyer
authors.affiliation: Service de Médecine Néonatale, Centre Hospitalier Intercommunal de Creteil, Clinical Research Center CHI Créteil, Créteil, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Scholer-Lascourrèges
authors.affiliation: Department of Néonatologie, Groupe Hospitalier Paris St Joseph 185 rue Raymond Losserand, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Boujenah
authors.affiliation: Pôle Femme-Enfant, CHU Rennes, Rennes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bétrémieux
authors.affiliation: Department of Neonatology, Hospices Civils de Lyon, Hôpital Femme mère enfants, Bron, France.|Claude Bernard University EAM 41-28, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Claris
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.
authors.forename: Micheline
authors.initials: M
authors.lastname: Garel
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.
authors.forename: Monique
authors.initials: M
authors.lastname: Kaminski
authors.affiliation: Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.|Service de Néonatologie, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Foix-L'Helias
authors.affiliation: Service de Médecine Néonatale, Centre Hospitalier Intercommunal de Creteil, Clinical Research Center CHI Créteil, Créteil, France.|CEDITEC (Centre d'Etude des discours, images, textes, écrits, communications) Université Paris Est Creteil UPEC, Creteil, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Caeymaex
mesh_terms: D003696:Delivery Rooms / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D008297:Male; D010166:Palliative Care; D011247:Pregnancy; D011446:Prospective Studies; D011795:Surveys and Questionnaires
keywords: Palliative Care; comfort care; delivery room; dying; extreme prematurity