Later rather than sooner: the impact of clinical management on timing and modes of death in the last decade

Abstract

Aim: Technological and clinical advances have reduced neonatal deaths, and this study explored how the mode and timing of neonatal deaths has changed in a tertiary neonatal intensive care unit (NICU) over 10 years.

Methods: We carried out a retrospective chart review on NICU deaths in 2000-2002 and 2007-2010, categorising deaths and compared the timing, cause and mode of death in the two cohorts.

Results: We analysed 204 neonatal deaths and found that the average age at death doubled from 9.71 days in 2000-2002 to 18.8 days (p = 0.014) in 2007-2010 and that the number of deaths in the first 48 h of life fell from 52% to 29% (p < 0.001). Mode of death and ethical decision-making was similar. In both cohorts, 26% of patients who died had a do not resuscitate order and 9% of the 151 patients without an order died while receiving cardiopulmonary resuscitation. Most neonates received medication to keep them comfortable and their use was similar in both cohorts.

Conclusion: Changes in neonatal management have led to a reduction in early deaths and an increase in age at death. The impact of later deaths on families and healthcare providers deserves further research.

Keywords: End-of-life care; Ethics; Modes of death; Neonatal intensive care unit; Palliative care.