@article {VerhagenF434, author = {A A E Verhagen and J H H M Dorscheidt and B Engels and J H Hubben and P J Sauer}, title = {Analgesics, sedatives and neuromuscular blockers as part of end-of-life decisions in Dutch NICUs}, volume = {94}, number = {6}, pages = {F434--F438}, year = {2009}, doi = {10.1136/adc.2008.149260}, publisher = {BMJ Publishing Group}, abstract = {Background: Clinicians frequently administer analgesics and sedatives at the time of withholding or withdrawal of life-sustaining treatment in newborns. This practice might be regarded as intentionally hastening of death.Objective: To describe type, doses and reasons for administering medications as part of end-of-life decisions in the Dutch neonatal intensive care units.Design and setting: We reviewed the medical files of 340 newborn deaths with a preceding end-of-life decision over a 12-month period to describe the use of analgesics, sedatives and/or neuromuscular blockers. The neonatologists of 147 of the 150 newborns with a preceding end-of-life decision based on the infant{\textquoteright}s poor prognosis were interviewed to obtain additional details about the use of medication.Results: Analgesics and sedatives were administered to 224 of 340 newborns before the end-of-life decision and to 292 newborns after the decision. The medication was increased in 94 of 289 newborns whose death was imminent and in 110 of 150 newborns with a poor prognosis. Reasons for the increase were treatment of pain and suffering, and in 4\% of cases hastening of death. Reasons were undocumented in 55\% of deaths. Neuromuscular blockers were administered in 16\% of patients because they already received these agents or to stop or prevent gasping.Conclusions: Analgesics and sedatives are generally increased after the end-of-life decision to treat pain and suffering and rarely to hasten death. Neuromuscular blockers were administered in 16\% of deaths. Medical files provide insufficient documentation of considerations leading to the increase of medication, which hinders (external) review.}, issn = {1359-2998}, URL = {https://fn.bmj.com/content/94/6/F434}, eprint = {https://fn.bmj.com/content/94/6/F434.full.pdf}, journal = {Archives of Disease in Childhood - Fetal and Neonatal Edition} }