Document Detail

Categorizing neonatal deaths: a cross-cultural study in the United States, Canada, and The Netherlands.
MedLine Citation:
PMID:  19772968     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To clarify the process of end-of-life decision-making in culturally different neonatal intensive care units (NICUs). STUDY DESIGN: Review of medical files of newborns >22 weeks gestation who died in the delivery room (DR) or the NICU during 12 months in 4 NICUs (Chicago, Milwaukee, Montreal, and Groningen). We categorized deaths using a 2-by-2 matrix and determined whether mechanical ventilation was withdrawn/withheld and whether the child was dying despite ventilation or physiologically stable but extubated for neurological prognosis. RESULTS: Most unstable patients in all units died in their parents' arms after mechanical ventilation was withdrawn. In Milwaukee, Montreal, and Groningen, 4% to 12% of patients died while receiving cardiopulmonary resuscitation. This proportion was higher in Chicago (31%). Elective extubation for quality-of-life reasons never occurred in Chicago and occurred in 19% to 35% of deaths in the other units. The proportion of DR deaths in Milwaukee, Montreal, and Groningen was 16% to 22%. No DR deaths occurred in Chicago. CONCLUSIONS: Death in the NICU occurred differently within and between countries. Distinctive end-of-life decisions can be categorized separately by using a model with uniform definitions of withholding/withdrawing mechanical ventilation correlated with the patient's physiological condition. Cross-cultural comparison of end-of-life practice is feasible and important when comparing NICU outcomes.
A A Eduard Verhagen; Annie Janvier; Steven R Leuthner; B Andrews; J Lagatta; Arend F Bos; William Meadow
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of pediatrics     Volume:  156     ISSN:  1097-6833     ISO Abbreviation:  J. Pediatr.     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2009-12-16     Completed Date:  2010-02-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0375410     Medline TA:  J Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  33-7     Citation Subset:  AIM; IM    
Department of Pediatrics, University Medical Center Groningen, Groningen, The Netherlands.
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MeSH Terms
Cross-Cultural Comparison
Decision Making*
Gestational Age
Infant, Newborn
Infant, Newborn, Diseases / mortality*
Intensive Care Units, Neonatal
Respiration, Artificial
Terminal Care
United States
Withholding Treatment / statistics & numerical data*
Comment In:
J Pediatr. 2010 Jan;156(1):7-9   [PMID:  20006758 ]

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