TY - JOUR T1 - End-of-life decisions for fragile neonates: navigating between opinion and evidence-based medicine JF - Archives of Disease in Childhood - Fetal and Neonatal Edition JO - Arch Dis Child Fetal Neonatal Ed SP - F96 LP - F97 DO - 10.1136/archdischild-2016-311123 VL - 102 IS - 2 AU - Annie Janvier AU - Barbara Farlow AU - Eduard Verhagen AU - Keith Barrington Y1 - 2017/03/01 UR - http://fn.bmj.com/content/102/2/F96.abstract N2 - The majority of neonatal deaths occur after a decision to limit life-sustaining interventions (LSIs).1 Decisions on when to withhold/withdraw LSIs in fragile neonates are among the most difficult decisions in paediatric practice. Two rigorous investigations shed some light on this topic. Durrmeyer et al2 systematically described the management of 73 delivery room deaths in the EPIPAGE-2 cohort. The vast majority of neonates had LSI withheld, at a median gestational age of 24 weeks. Pain was usually assessed: 50% of infants received comfort medication, the administration of which was not associated with the evaluation of pain but rather with the presence of gasping. Satisfaction of healthcare providers was strongly associated with the occurrence of parent-child contact, which frequently occurred. Aladangady et al3 describe the short-term outcome of LSI-limitation discussions with parents in a prospective multicentre trial in the UK (the WILST study). Half of the parents did not agree with providers and opted to continue LSI. When this occurred, it was not rare for the neonates to survive. When parents and providers agreed that LSI should be limited, neonates rarely survived.When examining these issues, three important questions should be considered: When should limitations of LSI be considered?How can we optimise communication with parents?4How should we care for dying neonates and their families?Fragile neonates can be grouped into three decision-making ‘zones’: (1) ‘Beneficial’, where LSIs are indicated because of good outcomes; … ER -