Withholding or withdrawing life-sustaining treatment in extremely low gestational age neonates. Issue 3 (20th October 2020)

• Record Type: Journal Article
• Authors: Dworetz, April R; Natarajan, Girija; Langer, John; Kinlaw, Kathy; James, Jennifer R; Bidegain, Margarita; Das, Abhik; Poindexter, Brenda; Bell, Edward F; Cotten, C M; Kirpalani, Haresh; Shankaran, Seetha; Stoll, Barbara J
• Other Names: author non-byline.; Higgins Rosemary D. author non-byline.; Archer Stephanie Wilson author non-byline.; Sokol Gregory M. author non-byline.; Wilson Leslie Dawn author non-byline.; Herron Dianne E. author non-byline.; Gunn Susan author non-byline.; Smiley Lucy author non-byline.; Kennedy Kathleen A. author non-byline.; Tyson Jon E. author non-byline.; Arldt-McAlister Julie author non-byline.; Burson Katrina author non-byline.; Dempsey Allison G. author non-byline.; Evans Patricia W. author non-byline.; Lillie Layne author non-byline.; Martin Karen author non-byline.; Martin Sara C. author non-byline.; McDavid Georgia E. author non-byline.; Rodgers Shawna author non-byline.; Layne Lillie M. author non-byline.; Patti L author non-byline.; Tate Pierce author non-byline.; Wright Sharon L. author non-byline.; Nelin Leif D. author non-byline.; Jadcherla Sudarshan R. author non-byline.; Sánchez Pablo J. author non-byline.; Fortney Christine A. author non-byline.; Seabrook Ruth author non-byline.; Luzader Patricia author non-byline.; Parikh Nehal A. author non-byline.; Wallace Dennis author non-byline.; Gantz Marie G. author non-byline.; Auman Jeanette O'Donnell author non-byline.; Crawford Margaret author non-byline.; Carolyn M author non-byline.; Huitema Petrie author non-byline.; Zaterka-Baxter Kristin M. author non-byline.; Van Meurs Krisa P. author non-byline.; Stevenson David K. author non-byline.; Bethany Ball M. author non-byline.; Proud Melinda S. author non-byline.; Carlo Waldemar A. author non-byline.; Ambalavanana Namasivayam author non-byline.; Collins Monica V. author non-byline.; Cosby Shirley S. author non-byline.; Devaskar Uday author non-byline.; Garg Meena author non-byline.; Chanlaw Teresa author non-byline.; Geller Rachel author non-byline.; Ellsbury Dan L. author non-byline.; Colaizy Tarah T. author non-byline.; Brumbaugh Jane E. author non-byline.; Johnson Karen J. author non-byline.; Walker Jacky R. author non-byline.; Campbell Donia B. author non-byline.; Watterberg Kristi L. author non-byline.; Ohls Robin K. author non-byline.; Lacy Conra Backstrom author non-byline.; Beauman Sandra Sundquist author non-byline.; Munson David author non-byline.; Schmidt Barbara author non-byline.; DeMauro Sara B. author non-byline.; Chaudhary Aasma S. author non-byline.; Abbasi Soraya author non-byline.; Mancini Toni author non-byline.; D'Angio Carl T. author non-byline.; Guillet Ronnie author non-byline.; Lakshminrusimha Satyan author non-byline.; Jensen Rosemary L. author non-byline.; Reubens Linda author non-byline.; Reynolds Anne Marie author non-byline.; Scorsone Ann Marie author non-byline.; Williams Ashley author non-byline.; Wynn Karen author non-byline.; Maffett Deanna author non-byline.; Prinzing Diane author non-byline.; Hunn Julianne author non-byline.; Guilford Stephanie author non-byline.; Rowan Mary author non-byline.; Sacilowski Michael author non-byline.; Wadkins Holly I.M. author non-byline.; Wyckoff Myra author non-byline.; Sánchez Pablo J. author non-byline.; Brion Luc P. author non-byline.; Vasil Diana M. author non-byline.; Chen Lijun author non-byline.; Guzman Alicia author non-byline.; Lee Lizette E. author non-byline.; Bara Rebecca author non-byline.; Barks John author non-byline.; Christensen Mary author non-byline.; Wiggins Stephanie author non-byline.; White Diane author non-byline.; author non-byline.; Polin Richard A. author non-byline.; Laptook Abbot R. author non-byline.; Keszler Martin author non-byline.; Hensman Angelita M. author non-byline.; Vieira Elisa author non-byline.; Little Emilee author non-byline.; Walsh Michele C. author non-byline.; Fanaroff Avroy A. author non-byline.; Hibbs Anna Marie author non-byline.; Newman Nancy S. author non-byline.; Truog William E. author non-byline.; Pallotto Eugenia K. author non-byline.; Gauldin Cheri author non-byline.; Holmes Anne author non-byline.; Johnson Kathy author non-byline.; Schibler Kurt author non-byline.; Alexander Barbara author non-byline.; Grisby Cathy author non-byline.; Goldberg Ronald N. author non-byline.; Fisher Kimberley A. author non-byline.; Finkle Joanne author non-byline.; Laughon Matthew M. author non-byline.; Bose Carl L. author non-byline.; Bernhardt Janice author non-byline.; Bose Gennie author non-byline.; Carlton David P. author non-byline.; Hale Ellen C. author non-byline.; Loggins Yvonne author non-byline.; Bottcher Diane I. author non-byline.;
• Is Part Of: Archives of disease in childhood. Volume 106:Issue 3(2021)
• Page Start: 238
• Page End: 243
• Publication Date: 2020-10-20
• Subjects: ethics -- neonatology -- palliative care -- race and health; Infants -- Diseases -- Periodicals; Newborn infants -- Diseases -- Periodicals; Fetus -- Diseases -- Periodicals; 618.920105
• DOI: 10.1136/archdischild-2020-318855
• Languages: English
• ISSNs: 1359-2998

Abstract

Abstract : 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.