PT  - JOURNAL ARTICLE
AU  - Verhagen, A A E
AU  - Dorscheidt, J H H M
AU  - Engels, B
AU  - Hubben, J H
AU  - Sauer, P J
TI  - Analgesics, sedatives and neuromuscular blockers as part of end-of-life decisions in Dutch NICUs
AID  - 10.1136/adc.2008.149260
DP  - 2009 Nov 01
TA  - Archives of Disease in Childhood - Fetal and Neonatal Edition
PG  - F434--F438
VI  - 94
IP  - 6
4099  - http://fn.bmj.com/content/94/6/F434.short
4100  - http://fn.bmj.com/content/94/6/F434.full
SO  - Arch Dis Child Fetal Neonatal Ed2009 Nov 01; 94
AB  - 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’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.