Article Text

PDF
Short-term outcome of treatment limitation discussions for newborn infants, a multicentre prospective observational cohort study
  1. Narendra Aladangady1,2,
  2. Chloe Shaw3,
  3. Katie Gallagher3,
  4. Elizabeth Stokoe4,
  5. Neil Marlow3,
  6. for Collaborators Group
    1. 1Neonatal Unit, Homerton University Hospital NHS Foundation Trust, London, UK
    2. 2Department of Paediatrics, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
    3. 3Academic Neonatology, UCL Institute for Women's Health, London, UK
    4. 4Department of Social Sciences, Loughborough University, Loughborough, UK
    1. Correspondence to Professor Narendra Aladangady, Consultant Neonatologist, Homerton University Hospital, Homerton Row, London E9 6SR, UK; narendra.aladangady{at}homerton.nhs.uk

    Abstract

    Objective To determine the short-term outcomes of babies for whom clinicians or parents discussed the limitation of life-sustaining treatment (LST).

    Design Prospective multicentre observational study.

    Setting Two level 3, six level 2 and one level 1 neonatal units in the North-East London Neonatal Network.

    Participants A total of 87 babies including 68 for whom limiting LST was discussed with parents and 19 babies died without discussion of limiting LST in the labour ward or neonatal unit.

    Outcome measures Final decision reached after discussions about limiting LST and neonatal unit outcomes (death or survived to discharge) for babies.

    Results Withdrawing LST, withholding LST and do not resuscitate (DNR) order was discussed with 48, 16 and 4 parents, respectively. In 49/68 (72%) cases decisions occurred in level 3 and 19 cases in level 2 units. Following the initial discussions, 34/68 parents made the decision to continue LST. In 33/68 cases, a second opinion was obtained. The parents of 14/48 and 2/16 babies did not agree to withdraw and withhold LST, respectively. Forty-seven out of 87 babies (54%) died following limitation of LST, 28/87 (32%) died receiving full intensive care support, 5/87 (6%) survived following a decision to limit LST and 7/87 (8%) babies survived following decision to continue LST.

    Conclusions A significant proportion of parents chose to continue treatment following discussions regarding limiting LST for their babies, and a proportion of these babies survived to neonatal unit discharge. The long-term outcomes of babies who survive following limiting LST discussion need to be investigated.

    • Withdrawal of life sustaining treatment
    • DNR Order
    • Newborn baby
    • Neonatal death
    • Limitation of life sustaining treatment

    Statistics from Altmetric.com

    Footnotes

    • Collaborators Bal Sharma, Queen's Hospital, Romford, Essex RM7 0AG; Bal Sharma, King George Hospital, Ilford, Essex IG3 8YB; Imdad Ali, Newham University Hospital, London E13 8SL; John Ho, Whipps Cross University Hospital, London E11 1NR; Lesley Alsford, North Middlesex University Hospital, London N18 1BX; Narendra Aladangady, Homerton University Hospital, London E9 6SR; Sam Mukherjee, Basildon University Hospital, Basildon, Essex SS16 5NL; Syed Mohinuddin, The Royal London Hospital, London E1 1BB; Thilani Ranasinghe, Southend University Hospital, Essex SS0 0RY.

    • Contributors NM and NA conceived the study, NM led the funding application and all contributors formulated the design and execution of the study. CS and NA reviewed and updated database and analysed the data. NA wrote the first draft and coordinated the manuscript. All authors were involved in interpretation of the data and writing the report. All have seen and approved the final version.

    • Funding The National Institute for Health Research (NIHR) funded the study (RP-DG-0611-10006). Neil Marlow receives part funding from the Department of Health's NIHR Biomedical Research Centre's funding scheme at UCLH/UCL. The study was sponsored by University College London.

    • Competing interests None declared.

    • Patient  consent Detail has been removed from these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

    • Ethics approval The study was approved by the East London Research Ethics Committee (REC no: 12/LO/1949), and by the Research and Development (R&D) Department of participating hospitals. Parent consent was not required as we used anonymised routinely collected data from medical records.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    Request permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Linked Articles

    • Editorial
      Annie Janvier Barbara Farlow Eduard Verhagen Keith Barrington
    • Original article
      Xavier Durrmeyer Claire Scholer-Lascourrèges Laurence Boujenah Pierre Bétrémieux Olivier Claris Micheline Garel Monique Kaminski Laurence Foix-L'Helias Laurence Caeymaex the EPIPAGE-2 Extreme Prematurity Writing Group the EPIPAGE-2 Extreme Prematurity Writing Group Elie Azria Alain Beuchée Pascal Boileau Frédérique Charlot Anaëlle Coquelin Caroline Diguisto Laurence Foix L'Hélias Pierre Kuhn Cerise Levaillant Florence Rouget Umberto Simeoni Barthélemy Tosello Patrick Truffert
    • Fantoms
      Ben Stenson