Neonatal hypoxic-ischaemic encephalopathy: most deaths followed end-of-life decisions within three days of birth

作者：Garcia Alix Alfredo^*; Arnaez Juan; Cortes Veronica; Girabent Farres Monserrat; Arca Gemma; Balaguer Albert

来源：Acta Paediatrica, 2013, 102(12): 1137-1143.

DOI：10.1111/apa.12420

• End-of-life care
• Hypoxic-ischaemic encephalopathy
• Neonatal death
• Withdrawal
• Withholding

AimTo investigate the circumstances surrounding end-of life decisions (EoL) of infants with hypoxic-ischaemic encephalopathy (HIE) and examine changes over a 10-year period. %26lt;br%26gt;MethodsRetrospective chart review of all infants with HIE who died during 2000-2004 and 2005-2009 in a Level III Neonatal Intensive Care Unit in Madrid, Spain. %26lt;br%26gt;ResultsOf 70 infants with HIE, 18 died during the neonatal period. The mean age of death was 64.451h. In 17 of the 18 infants (94%), death was preceded by an EoL decision, four after withholding therapy (WH) and 13 after withdrawal therapy (WDT). All infants with WH were previously stable and without respiratory support, while all 13 infants in the WDT group had respiratory support and three were unstable. The age of death was greater in the WH group than the WDT group (122 +/- 63h vs 50 +/- 34; p%26lt;0.001). After the EoL decision, 11 (65%) infants received sedatives. There were no differences between the time periods. %26lt;br%26gt;ConclusionIn our cohort, most deaths in newborns with HIE were preceded by EoL decisions mainly within the first 3days after birth. We did not find changes over the first decade of the 21st century, and death was mainly determined by WDT.

• 出版日期2013-12