Neonatal end-of-life practice in a German perinatal centre

Acta Paediatr. 2007 May;96(5):681-7. doi: 10.1111/j.1651-2227.2007.00234.x.

Abstract

Aim: To investigate the end-of-life practice in a large perinatal centre in Germany.

Methods: Retrospective chart review was performed in all neonates deceased in the delivery room (n = 31) and the neonatal intensive care unit (n = 47) between 2002 and 2004.

Results: Neonatal death was preceded by an end-of-life decision (EOLD) in 81% of cases in the delivery room and 83% in the neonatal intensive care unit. The majority of deceased neonates were born prematurely or with congenital malformation. Life-sustaining treatment was not initiated in 74% of the infants deceased in the delivery room. In the unit, 52% died after withdrawal of therapy. Mechanical ventilation was withdrawn most frequently (79% of cases). Futility and immediate death were common considerations in EOLD, but the infant's suffering and future quality of life also played a role. Parents were involved in EOLD-making in all but emergency cases. No active termination of life was performed.

Conclusion: In our perinatal centre, the majority of neonatal deaths occurred after limitation of therapy. Treatment was actively withdrawn in half of the infants in the neonatal intensive care unit. Actual end-of-life practice in a large perinatal centre differs from the restrictive attitude towards EOLD reported for German neonatologists in previous surveys.

MeSH terms

  • Delivery Rooms / statistics & numerical data*
  • Female
  • Germany
  • Gestational Age
  • Humans
  • Infant Mortality*
  • Infant, Newborn
  • Intensive Care Units, Neonatal / statistics & numerical data*
  • Logistic Models
  • Male
  • Medical Audit
  • Medical Futility
  • Neonatology
  • Quality of Life
  • Respiration, Artificial
  • Retrospective Studies
  • Terminal Care*