How infants die in the neonatal intensive care unit: trends from 1999 through 2008

Arch Pediatr Adolesc Med. 2011 Jul;165(7):630-4. doi: 10.1001/archpediatrics.2011.102.


Objective: To determine whether trends toward decreasing use of cardiopulmonary resuscitation at the time of death and increasing frequency of forgoing life-sustaining treatment had continued, as few studies quantifying mode of death for hospitalized infants have been conducted in the last 10 years.

Design: Retrospective descriptive study.

Setting: Regional referral neonatal intensive care unit.

Participants: Infants who died from January 1, 1999, to December 31, 2008. Infants were categorized into following categories: (1) very preterm (≤32 weeks' gestation); (2) congenital anomaly; and (3) other.

Main outcome measures: The primary outcome was level of clinical service provided at the end of life (care withheld, care withdrawn, or full resuscitation).

Results: For 10 years, 414 neonatal patients died. Of these, 61.6% had care withdrawn, 20.8% had care withheld, and 17.6% received cardiopulmonary resuscitation. The percentage of deaths that followed withholding of treatment rose by 1% per year (P = .01). Most of this change was accounted for by withholding of therapy in the very premature group.

Conclusion: During the 10-year period, the primary mode of death in this regional referral neonatal intensive care unit was withdrawal of life-sustaining support. When death is imminent or medical care is considered futile, the approach is thought to provide a peaceful, controlled setting. Significant increase in withholding of care suggests improved recognition of medical futility and desire to provide a peaceful death.

MeSH terms

  • Cardiopulmonary Resuscitation / statistics & numerical data*
  • Cause of Death*
  • Chi-Square Distribution
  • Female
  • Hospital Mortality / trends*
  • Humans
  • Infant Mortality / trends*
  • Infant, Newborn
  • Intensive Care Units, Neonatal
  • Linear Models
  • Male
  • Retrospective Studies
  • Statistics, Nonparametric
  • Withholding Treatment*