title: Short-term outcome of treatment limitation discussions for newborn infants, a multicentre prospective observational cohort study.
abstract: OBJECTIVE
  To determine the short-term outcomes of babies for whom clinicians or parents discussed the limitation of life-sustaining treatment (LST).
  
  
  METHODS
  Prospective multicentre observational study.
  
  
  METHODS
  Two level 3, six level 2 and one level 1 neonatal units in the North-East London Neonatal Network.
  
  
  METHODS
  A total of 87 babies including 68 for whom limiting LST was discussed with parents and 19 babies died without discussion of limiting LST in the labour ward or neonatal unit.
  
  
  METHODS
  Final decision reached after discussions about limiting LST and neonatal unit outcomes (death or survived to discharge) for babies.
  
  
  RESULTS
  Withdrawing LST, withholding LST and do not resuscitate (DNR) order was discussed with 48, 16 and 4 parents, respectively. In 49/68 (72%) cases decisions occurred in level 3 and 19 cases in level 2 units. Following the initial discussions, 34/68 parents made the decision to continue LST. In 33/68 cases, a second opinion was obtained. The parents of 14/48 and 2/16 babies did not agree to withdraw and withhold LST, respectively. Forty-seven out of 87 babies (54%) died following limitation of LST, 28/87 (32%) died receiving full intensive care support, 5/87 (6%) survived following a decision to limit LST and 7/87 (8%) babies survived following decision to continue LST.
  
  
  CONCLUSIONS
  A significant proportion of parents chose to continue treatment following discussions regarding limiting LST for their babies, and a proportion of these babies survived to neonatal unit discharge. The long-term outcomes of babies who survive following limiting LST discussion need to be investigated.
authors.affiliation: Neonatal Unit, Homerton University Hospital NHS Foundation Trust, London, UK.|Department of Paediatrics, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
authors.forename: Narendra
authors.initials: N
authors.lastname: Aladangady
authors.affiliation: Academic Neonatology, UCL Institute for Women's Health, London, UK.
authors.forename: Chloe
authors.initials: C
authors.lastname: Shaw
authors.affiliation: Academic Neonatology, UCL Institute for Women's Health, London, UK.
authors.forename: Katie
authors.initials: K
authors.lastname: Gallagher
authors.affiliation: Department of Social Sciences, Loughborough University, Loughborough, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stokoe
authors.affiliation: Academic Neonatology, UCL Institute for Women's Health, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Marlow
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D008020:Life Support Care / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010290:Parents; D011446:Prospective Studies; D016414:Resuscitation Orders; D028761:Withholding Treatment / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: DNR Order; Limitation of life sustaining treatment; Neonatal death; Newborn baby; Withdrawal of life sustaining treatment