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Original article
Delivery room deaths of extremely preterm babies: an observational study
  1. Xavier Durrmeyer1,2,
  2. Claire Scholer-Lascourrèges2,
  3. Laurence Boujenah3,
  4. Pierre Bétrémieux4,
  5. Olivier Claris5,6,
  6. Micheline Garel1,
  7. Monique Kaminski1,
  8. Laurence Foix-L'Helias1,7,
  9. Laurence Caeymaex2,8,
  10. the EPIPAGE-2 Extreme Prematurity Writing Group
    1. 1Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France
    2. 2Service de Médecine Néonatale, Centre Hospitalier Intercommunal de Creteil, Clinical Research Center CHI Créteil, Créteil, France
    3. 3Department of Néonatologie, Groupe Hospitalier Paris St Joseph 185 rue Raymond Losserand, Paris, France
    4. 4Pôle Femme-Enfant, CHU Rennes, Rennes, France
    5. 5Department of Neonatology, Hospices Civils de Lyon, Hôpital Femme mère enfants, Bron, France
    6. 6Claude Bernard University EAM 41-28, Lyon, France
    7. 7Service de Néonatologie, Hôpital Armand Trousseau, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, Paris, France
    8. 8CEDITEC (Centre d'Etude des discours, images, textes, écrits, communications) Université Paris Est Creteil UPEC, Creteil, France
    1. Correspondence to Dr Laurence Caeymaex, Service de Réanimation Néonatale, CH Intercommunal Créteil, 40 Avenue de Verdun, Creteil 94000, France; Laurence.caeymaex{at}chicreteil.fr

    Abstract

    Objective Many extremely preterm neonates die in the delivery room (DR) after decisions to withhold or withdraw life-sustaining treatments or after failed resuscitation. Specific palliative care is then recommended but sparse data exist about the actual management of these dying babies. The objective of this study was to describe the clinical course and management of neonates born between 22 and 26 weeks of gestation who died in the DR in France.

    Design, setting, patients Prospective study including neonates, who were liveborn between 22+0 and 26+6 weeks of gestation and died in the DR in 2011, among infants included in the EPIPAGE-2 study at the 18 centres participating in this substudy of extremely preterm neonates. Data were collected by a questionnaire completed by the professional caring for each baby.

    Results The study included 73 children, with a median (IQR) gestational age of 24 (23–24) weeks. Median (IQR) duration of life was 53 (20–82) min. All but one were both wrapped and warmed. Pain was assessed for 72%, although without using any scale. Gasping was described for 66%. Comfort medications were administered to 35 children (50%), significantly more frequently to babies with gasping (p=0.001). Mother–child contact was reported for 78%, and psychological support offered to parents of 92%.

    Conclusions Non-pharmacological comfort care and parental support were routinely given. Comfort medication was given much more frequently than previously reported in other DRs. These data should encourage work on the indications for comfort medication and the interpretation of gasping.

    • extreme prematurity
    • comfort care
    • delivery room
    • Palliative Care
    • dying

    https://doi.org/10.1136/archdischild-2016-310718

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      Footnotes

      • Collaborators Extreme Prematurity Writing Group: Elie Azria, Pierre Bétrémieux, Alain Beuchée, Pascal Boileau, Laurence Boujenah, Laurence Caeymaex, Frédérique Charlot, Olivier Claris, Anaëlle Coquelin, Caroline Diguisto, Micheline Garel, Laurence Foix L'Hélias, Monique Kaminski, Pierre Kuhn, Cerise Levaillant, Florence Rouget, Umberto Simeoni, Barthélemy Tosello, Patrick Truffert.

      • Contributors XD participated in the data analysis and interpretation and writing of the manuscript. CS-L and LB participated in the data collection, interpretation and writing of the manuscript. PB, MG, LFLH and MK initiated and designed the protocol, and participated in the data interpretation and writing of the manuscript. OC participated in writing the manuscript. LC initiated and designed the protocol, participated in the data collection and interpretation and in writing the manuscript. All the co-authors approved the final manuscript.

      • Funding This work was supported by a grant from the Fondation de France (http://www.fondationdefrance.org), which had no role in the design and conduct of the study, the collection, analysis or interpretation of data or writing of the report.

      • Competing interests None declared.

      • Ethics approval Consultative Committee on the Treatment of Information on Personal Health Data for Research Purposes (no 10.626); Committee for the Protection of People participating in Biomedical Research (no CPP SC-2873); The National Data Protection Authority (CNIL no 911009).

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

      • Data sharing statement The original version of the questionnaire is available to readers by asking the corresponding author.

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