Background
Methods
Design, setting and participants
Data collection
Questionnaire and variables
The following cause of death categories were identified: - Prematurity and related disorders: Death due to a direct cause of prematurity, immaturity or disorders related to prematurity. For example, necrotizing enterocolitis, intraventricular hemorrhage, respiratory distress syndrome, or death due to (extremely) low birth weight or low gestational age. - Congenital anomalies - singular: Death due to a single congenital anomaly with a defect in one organ or organ system. For example, a congenital malformation of the heart or a spina bifida. - Congenital anomalies - multiple or systemic disorders: Death due to the presence of multiple congenital anomalies in different organ systems, or due to a disorder that affects multiple organ systems. For example, chromosomal disorders, multiple congenital malformations diagnosed in one infant, or an inborn error of metabolism. - Complications of pregnancy with repercussions on foetal growth or development: Infant died due to complications of pregnancy that had an influence on the growth or the health of the baby prenatally. For example, a cytomegalovirus infection with congenital infection of the foetus, or pre-eclampsia with severe intrauterine growth restriction. - Acute complications of pregnancy and/or birth in a previously healthy foetus. For example, a placental abruption or birth trauma causing oxygen deprivation. - Disorders acquired after birth: Death due to a non-congenital disorder, acquired after birth of a previously healthy baby. For example, infectious diseases resulting in multiple organ failure. - Other: Cause of death was sudden, without previous diagnoses. Examples are sudden infant death syndrome, accidents or trauma. |
Statistical analysis
Results
% | |
---|---|
Sex | |
Male | 61.4 |
Female | 38.6 |
Place of death | |
NICU | 63.6 |
Other | 36.4 |
Age at death | |
Early neonatal death (<7 days) | 49.3 |
Late neonatal death (7-27 days) | 22.9 |
Post neonatal death (>27 days) | 27.9 |
Gestational age at birth | |
< 26 weeks | 31.1 |
26-28 weeks | 15.2 |
29-31 weeks | 6.1 |
32-36 weeks | 10.6 |
≥ 37 weeks | 37.1 |
Congenital anomalies | |
Yes (single or multiple) | 40.7 |
No | 59.3 |
Severity of congenital anomaliesa | |
Very serious | 59.6 |
Serious | 24.6 |
Moderate/mildb | 15.8 |
Main cause of death | |
Prematurity and related disorders | 20.0 |
Congenital anomalies singular | 20.0 |
Congenital anomalies multiple | 17.1 |
Complications of the pregnancy with repercussions for the foetus | 19.3 |
Acute complications of the pregnancy and/or birth in a healthy foetus | 13.6 |
Disorders acquired after birth + other disordersb | 10.0 |
All ELDs | Non-treatment decisions | Medication administration | p-valuea | |||
---|---|---|---|---|---|---|
Withholding treatment (n= 19% of all cases) | Withdrawing treatment (n= 41% of all cases) | Medication with hastening death taken into account or co-intended (n= 22% of all cases) | Medication with an explicit intention to hasten death (n= 17% of all cases) | |||
Consultation of physician with the parents? | 0.002 | |||||
Yes | 92% | 92% | 96% | 74% | 100% | |
No | 8% | 8% | 4% | 26% | 0% | |
If parents were consulted (n= 92% of cases): | ||||||
Was the ELD based on an explicit request from the parents? | 0.076 | |||||
Yes | 28% | 33% | 22% | 15% | 46% | |
No | 72% | 67% | 78% | 85% | 54% | |
Was there agreement about the ELD? | 0.645 | |||||
Yes, with both parents | 96% | 92% | 96% | 100% | 96% | |
Yes, with the mother | 0% | 0% | 0% | 0% | 0% | |
No or only with the fatherb | 4% | 8% | 4% | 0% | 4% | |
Were the parents capable of assessing the medical situation of the infant and making an adequate decision? | 0.617 | |||||
Yes | 92% | 87% | 92% | 95% | 92% | |
No, not at all or not fully capablec | 8% | 13% | 8% | 5% | 8% |
n=8% of all cases | |
---|---|
Reasons for not consulting parents | |
Not needed, medical situation was clear | 89% |
Other | 11% |
Life-shortening intention of the physician | |
No intention to shorten life | 64% |
Co-intention to shorten life | 9% |
Explicit intention to shorten life | 27% |
Estimated time by which life was shortened | |
> 4 weeks | 9% |
1-4 weeks | 0% |
1-7 days | 0% |
< 24 hours | 18% |
No shortening of life | 73% |
Reason for the ELD | |
No real chance of survival | 80% |
No hope of a bearable future | 0% |
Other | 20% |
All ELDs | Non-treatment decisions | Medication administration | p-value | |||
---|---|---|---|---|---|---|
Withholding treatment (n= 19% of all cases) | Withdrawing treatment (n= 41% of all cases) | Medication with hastening death taken into account or co-intended (n= 22% of all cases) | Medication with an explicit intention to hasten death (n= 17% of all cases) | |||
Consultation with other physicians/healthcare professionals (multiple answers possible) | ||||||
Yes, with individual colleagues | 43% | 50% | 44% | 37% | 38% | 0.741 |
Yes, during an open team meeting | 56% | 39% | 57% | 59% | 67% | 0.212 |
No | 10% | 12% | 9% | 19% | 0% | 0.189 |
If consulted with other professionals, who? (multiple answers possible) | ||||||
Neonatologist | 71% | 74% | 68% | 73% | 91% | 0.241 |
Nurse | 42% | 35% | 40% | 58% | 48% | 0.144 |
Pediatrician | 30% | 26% | 40% | 23% | 23% | 0.388 |
Other physician | 27% | 13% | 38% | 27% | 23% | 0.165 |
Gynecologist | 20% | 52% | 11% | 12% | 22% | <0.001 |
Family other than the parents | 11% | 9% | 11% | 12% | 13% | 0.980 |
Othersa | 3% | 0% | 6% | 4% | 0% | 0.444 |
Was an ethics committee consulted? | 0.003 | |||||
Yes, before the ELD | 2% | 0% | 0% | 0% | 13% | |
Yes, after the ELD | 0% | 0% | 0% | 0% | 0% | |
No | 98% | 100% | 100% | 100% | 87% |