No resuscitation and withdrawal of therapy in a neonatal and a pediatric intensive care unit in Canada

Abstract

Study objective: To compare and contrast the modes of death in a neonatal (NICU) and a pediatric (PICU) intensive care unit.

Design: Retrospective analysis of patient records.

Subjects: All newborn infants and children (< 17 years of age) who died in the NICU and PICU at the University of Alberta Hospitals, Edmonton, between Jan. 1, 1990, to Dec. 31, 1991.

Results: The mortality rate in the PICU was 8.7% (73/839) compared with 5.6% (75/1333) in the NICU (p = 0.007). Withdrawal of therapy was the most common cause of death in both units and occurred more commonly in the NICU (NICU = 69% vs PICU = 34%; p = 0.01). There were significantly more deaths as a result of failed cardiopulmonary resuscitation (CPR) in the PICU than in the NICU (29% vs 13%; p = 0.046). Death after no-CPR orders occurred with equal frequency in both units (NICU 17%; PICU 15%). Brain death accounted for 22% (16/87) of PICU deaths; no infant in the NICU was declared brain dead (p < 0.05). When deaths resulting from brain death and failed CPR were excluded, there was no significant difference between the two units regarding withdrawal of therapy (NICU 80% vs PICU 69%) and no-CPR orders (NICU 20% vs PICU 30%).

Conclusions: This study confirms that both withdrawal of therapy and no-CPR orders are part of current clinical practice in both the NICU and PICU settings. The ethical foundations and implications of these practices need further elaboration.