Faculty Collaboration Database

Center, Gestational Age, and Race Impact End-of-Life Care Practices at Regional Neonatal Intensive Care Units. J Pediatr 2020 Feb;217:86-91.e1

Date

12/14/2019

Pubmed ID

31831163

DOI

10.1016/j.jpeds.2019.10.039

Scopus ID

2-s2.0-85076241563 (requires institutional sign-in at Scopus site)   14 Citations

Abstract

OBJECTIVE: To assess the impact of intercenter variation and patient factors on end-of-life care practices for infants who die in regional neonatal intensive care units (NICUs).

STUDY DESIGN: We conducted a retrospective cohort analysis using the Children's Hospital Neonatal Database during 2010-2016. A total of 6299 nonsurviving infants cared for in 32 participating regional NICUs were included to examine intercenter variation and the effects of gestational age, race, and cause of death on 3 end-of-life care practices: do not attempt resuscitation orders (DNR), cardiopulmonary resuscitation within 6 hours of death (CPR), and withdrawal of life-sustaining therapies (WLST). Factors associated with these practices were used to develop a multivariable equation.

RESULTS: Dying infants in the cohort underwent DNR (55%), CPR (21%), and WLST (73%). Gestational age, cause of death, and race were significantly and differently associated with each practice: younger gestational age (<28 weeks) was associated with CPR (OR 1.7, 95% CI 1.5-2.1) but not with DNR or WLST, and central nervous system injury was associated with DNR (1.6, 1.3-1.9) and WLST (4.8, 3.7-6.2). Black race was associated with decreased odds of WLST (0.7, 0.6-0.8). Between centers, practices varied widely at different gestational ages, race, and causes of death.

CONCLUSIONS: From the available data on end-of-life care practices for regional NICU patients, variability appears to be either individualized or without consistency.

Author List

Fry JT, Matoba N, Datta A, DiGeronimo R, Coghill CH, Natarajan G, Brozanski B, Leuthner SR, Niehaus JZ, Schlegel AB, Shah A, Zaniletti I, Bartman T, Murthy K, Sullivan KM, Children's Hospital Neonatal Consortium (CHNC)

Author

Steven R. Leuthner MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cardiopulmonary Resuscitation
Cause of Death
Databases, Factual
Female
Gestational Age
Hospitals, Pediatric
Humans
Infant, Newborn
Infant, Newborn, Diseases
Intensive Care Units, Neonatal
Intensive Care, Neonatal
Male
Multivariate Analysis
Resuscitation Orders
Retrospective Studies
Terminal Care
United States