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Withdrawal of Life Support Main Mode of NICU Deaths

Withholding treatment associated with significant 1 percent increase in deaths per year

WEDNESDAY, July 6 (HealthDay News) -- Withdrawing life-sustaining support is the primary mode of death in the neonatal intensive care unit (NICU), and there has been a significant annual increase in withholding of care, according to a study published in the July issue of the Archives of Pediatrics & Adolescent Medicine.

Julie Weiner, D.O., from the University of Missouri in Kansas City, and colleagues investigated whether trends toward decreasing use of cardiopulmonary resuscitation at the time of neonatal death and increasing frequency of forgoing life-sustaining treatment, increased from 1999 through 2008. Data from 414 infants who died in the NICU were analyzed. Based on the cause of death, infants were divided into very preterm (≤32 weeks' gestation), congenital anomaly, and other. The level of clinical service provided at the end of life, including care withheld, care withdrawn, or full resuscitation, was the primary outcome evaluated.

The investigators found that 61.6 percent of the neonatal patients who died had care withdrawn, 20.8 percent had care withheld, and 17.6 percent received cardiac resuscitation. Withholding treatment was associated with a significant 1 percent increase in deaths per year, with withholding of therapy in the very premature group being the primary cause for the increase.

"During the 10-year period, the primary mode of death in this regional referral neonatal intensive care unit was withdrawal of life-sustaining support," the authors write. "Significant increase in withholding of care suggests improved recognition of medical futility and desire to provide a peaceful death."

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