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Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates.

Publication ,  Journal Article
Dworetz, AR; Natarajan, G; Langer, J; Kinlaw, K; James, JR; Bidegain, M; Das, A; Poindexter, B; Bell, EF; Cotten, CM; Kirpalani, H; Stoll, BJ ...
Published in: Arch Dis Child Fetal Neonatal Ed
May 2021

OBJECTIVE: To identify sociodemographic and clinical factors associated with withholding or withdrawing life-sustaining treatment (WWLST) for extremely low gestational age neonates. DESIGN: Observational study of prospectively collected registry data from 19 National Institute of Child Health and Human Development Neonatal Research Network centres on neonates born at 22-28 weeks gestation who died >12 hours through 120 days of age during 2011-2016. Sociodemographic and clinical factors were compared between infants who died following WWLST and without WWLST. RESULTS: Of 1168 deaths, 67.1% occurred following WWLST. Withdrawal of assisted ventilation (97.4%) was the primary modality. WWLST rates were inversely proportional to gestational age. Life-sustaining treatment was withheld or withdrawn more often for non-Hispanic white infants than for non-Hispanic black infants (72.7% vs 60.4%; 95% CI 1.00 to 1.92) or Hispanic infants (72.7% vs 67.2%; 95% CI 1.32 to 3.72). WWLST rates varied across centres (38.6-92.6%; p<0.001). The centre with the highest rate had adjusted odds 4.89 times greater than the average (95% CI 1.18 to 20.18). The adjusted odds of WWLST were higher for infants with necrotiing enterocolitis (OR 1.77, 95% CI 1.21 to 2.59) and severe brain injury (OR 1.98, 95% CI 1.44 to 2.74). CONCLUSIONS: Among infants who died, WWLST rates varied widely across centres and were associated with gestational age, race, ethnicity, necrotiing enterocolitis, and severe brain injury. Further exploration is needed into how race, centre, and approaches to care of infants with necrotiing enterocolitis and severe brain injury influence WWLST.

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Published In

Arch Dis Child Fetal Neonatal Ed

DOI

EISSN

1468-2052

Publication Date

May 2021

Volume

106

Issue

3

Start / End Page

238 / 243

Location

England

Related Subject Headings

  • Withholding Treatment
  • United States
  • Sociological Factors
  • Race Factors
  • Pediatrics
  • Mortality
  • Male
  • Life Support Care
  • Infant, Newborn, Diseases
  • Infant, Newborn
 

Citation

APA
Chicago
ICMJE
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Dworetz, A. R., Natarajan, G., Langer, J., Kinlaw, K., James, J. R., Bidegain, M., … Human Development Neonatal Research Network, . (2021). Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates. Arch Dis Child Fetal Neonatal Ed, 106(3), 238–243. https://doi.org/10.1136/archdischild-2020-318855
Dworetz, April R., Girija Natarajan, John Langer, Kathy Kinlaw, Jennifer R. James, Margarita Bidegain, Abhik Das, et al. “Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates.Arch Dis Child Fetal Neonatal Ed 106, no. 3 (May 2021): 238–43. https://doi.org/10.1136/archdischild-2020-318855.
Dworetz AR, Natarajan G, Langer J, Kinlaw K, James JR, Bidegain M, et al. Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates. Arch Dis Child Fetal Neonatal Ed. 2021 May;106(3):238–43.
Dworetz, April R., et al. “Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates.Arch Dis Child Fetal Neonatal Ed, vol. 106, no. 3, May 2021, pp. 238–43. Pubmed, doi:10.1136/archdischild-2020-318855.
Dworetz AR, Natarajan G, Langer J, Kinlaw K, James JR, Bidegain M, Das A, Poindexter B, Bell EF, Cotten CM, Kirpalani H, Shankaran S, Stoll BJ, Eunice Kennedy Shriver National Institute of Child Health, Human Development Neonatal Research Network. Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates. Arch Dis Child Fetal Neonatal Ed. 2021 May;106(3):238–243.

Published In

Arch Dis Child Fetal Neonatal Ed

DOI

EISSN

1468-2052

Publication Date

May 2021

Volume

106

Issue

3

Start / End Page

238 / 243

Location

England

Related Subject Headings

  • Withholding Treatment
  • United States
  • Sociological Factors
  • Race Factors
  • Pediatrics
  • Mortality
  • Male
  • Life Support Care
  • Infant, Newborn, Diseases
  • Infant, Newborn