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. 2017 Jun 15;7(6):e015179.
doi: 10.1136/bmjopen-2016-015179.

Retrospective cohort study of all deaths among infants born between 22 and 27 completed weeks of gestation in Switzerland over a 3-year period

T M Berger  1 , M A Steurer  2 , H U Bucher  3 , J C Fauchère  3 , M Adams  3 , R E Pfister  4 , R Baumann-Hölzle  5 , D Bassler  3 ; Swiss Neonatal End-of-Life Study Group
Affiliations

Retrospective cohort study of all deaths among infants born between 22 and 27 completed weeks of gestation in Switzerland over a 3-year period

T M Berger et al. BMJ Open. .

Abstract

Objectives: The aim of this research is to assess causes and circumstances of deaths in extremely low gestational age neonates (ELGANs) born in Switzerland over a 3-year period.

Design: Population-based, retrospective cohort study.

Setting: All nine level III perinatal centres (neonatal intensive care units (NICUs) and affiliated obstetrical services) in Switzerland.

Patients: ELGANs with a gestational age (GA) <28 weeks who died between 1 July 2012 and 30 June 2015.

Results: A total of 594 deaths were recorded with 280 (47%) stillbirths and 314 (53%) deaths after live birth. Of the latter, 185 (59%) occurred in the delivery room and 129 (41%) following admission to an NICU. Most liveborn infants dying in the delivery room had a GA ≤24 weeks and died following primary non-intervention. In contrast, NICU deaths occurred following unrestricted life support regardless of GA. End-of-life decision-making and redirection of care were based on medical futility and anticipated poor quality of life in 69% and 28% of patients, respectively. Most infants were extubated before death (87%).

Conclusions: In Switzerland, most deaths among infants born at less than 24 weeks of gestation occurred in the delivery room. In contrast, most deaths of ELGANs with a GA ≥24 weeks were observed following unrestricted provisional intensive care, end-of-life decision-making and redirection of care in the NICU regardless of the degree of immaturity.

Keywords: end-of-life decision-making; extremely low gestational age neonates; live birth; redirection of care; stillbirth.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Overview of the study population (n=594). DR, delivery room; LTOP, late termination of pregnancy; NICU, neonatal intensive care unit.
Figure 2
Figure 2
Kaplan-Meier survival curves for infants admitted to the NICU (n=129): redirection of care (ROC) because of medical futility (n=89) versus ROC because of anticipated poor quality of life (n=36) (information on reason for ROC missing for three patients). NICU, neonatal intensive care unit.
See this image and copyright information in PMC

References

    1. Doyle LW, Roberts G, Anderson PJ, et al. . Outcomes at age 2 years of infants < 28 weeks' gestational age born in Victoria in 2005. J Pediatr 2010;156:49–53. 10.1016/j.jpeds.2009.07.013 - DOI - PubMed
    1. Horbar JD, Badger GJ, Carpenter JH, et al. . Trends in mortality and morbidity for very low birth weight infants, 1991–1999. Pediatrics 2002;110:143–51. 10.1542/peds.110.1.143 - DOI - PubMed
    1. Meadow W, Lee G, Lin K, et al. . Changes in mortality for extremely low birth weight infants in the 1990s: implications for treatment decisions and resource use. Pediatrics 2004;113:1223–9. 10.1542/peds.113.5.1223 - DOI - PubMed
    1. Stevenson DK, Wright LL, Lemons JA, et al. . Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1993 through December 1994. Am J Obstet Gynecol 1998;179:1632–9. 10.1016/S0002-9378(98)70037-7 - DOI - PubMed
    1. Neonatal medicine - Nuffield Bioethics. http://nuffieldbioethics.org/project/neonatal-medicine/ (accessed 11 Aug 2016).

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