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

• Published in: Acta Paediatrica Vol. 96; no. 5; pp. 681 - 687
• Main Authors: Schulz-Baldes, A, Huseman, D, Loui, A, Dudenhausen, JW, Obladen, M
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-05-2007; Blackwell
• Subjects: Biological and medical sciences; Delivery Rooms - statistics & numerical data; End-of-life decision; Ethics; Female; General aspects; Germany; Gestational Age; Humans; Infant Mortality; Infant, Newborn; Intensive Care Units, Neonatal - statistics & numerical data; Limitation of therapy; Logistic Models; Male; Medical Audit; Medical ethics; Medical Futility; Medical sciences; Neonatal intensive care; Neonatology; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Life; Respiration, Artificial; Retrospective Studies; Surrogate decision making; Teaching. Deontology. Ethics. Legislation; Terminal Care; Europe; Germany; Human; Therapy; Neonatal; Intensive care; Decision making; End of life decision; Perinatal; Neonatal intensive care; German; End of life; End-of-life decision; Medical ethics; Medicine; Ethics; Newborn; Treatment; Surrogate decision making; Limitation; Professional practice; Decision aid; Public health; Limitation of therapy
• ISSN: 0803-5253; 1651-2227
• DOI: 10.1111/j.1651-2227.2007.00234.x

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 Mechanical ventilation was withdrawn most frequently (79% of cases).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 Treatment was actively withdrawn in half of the infants in the neonatal intensive care unit.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.