Foregoing intensive care treatment in newborn infants with extremely poor prognoses:: A study in four neonatal intensive care units in the Netherlands☆,☆☆,★
Section snippets
METHODS
In 1993, 195,673 infants were born alive in the Netherlands. Of these infants, 3780 (1.9%) were admitted to the 10 Dutch level III neonatal intensive care units. Of the total admissions, 1284 (34%) occurred at the four participating units in this study. This study focuses on all infants who died in 1993 in these four units.
The infants were classified in six categories according to the report “Doen of Laten?” (”To do or not to do?”) of the Dutch Society of Paediatrics.7 The six categories and
RESULTS
This study is based on 181 neonatal cases. Gestational ages and birth weights for the study patients and for the total number of patients admitted at the four sites are reported in Table I. The lowest gestational age and birth weight groups were overrepresented in the study group. Table II lists the classification and treatment choices of the study cases. No cases involving the intentional and active termination of the patient's life (category 4 cases) occurred in this population.
DISCUSSION
The neonatal units involved in this study also conducted a study in 1990 of the 185 patient deaths in their units in that year.8 In that study, it was found that intensive care had not been started in 9% of the cases. In 31% of the cases intensive care had been withdrawn because of the absence of a realistic chance of survival. In 19% of the cases intensive care had been withdrawn because of extremely poor prognoses. In 40% of the cases, intensive treatment had been continued until the
Acknowledgements
We thank Douglas Brown, PhD, associate professor with the Louisiana State University School of Medicine, Department of Obstetrics and Gynecology, for his help in preparing this article.
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From the Department of Neonatology, Emma Children's Hospital Academic Medical Center, University of Amsterdam, Amsterdam, the Department of Pediatrics, University Hospital Leiden, Leiden, the Department of Neonatology, St. Joseph Hospital Veldhoven, Veldhoven, and the Department of Pediatrics, Neonatal Unit, University Hospital Nijmegen, Nijmegen, The Netherlands
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Reprint requests: Richard de Leeuw, MD, PhD, Academical Medical Center, University of Amsterdam, Emma Children's Hospital, Department of Neonatology, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands.
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0022-3476/96/$5.00 + 0 9/21/75978