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End-of-life decisions in neonates and infants : a nationwide mortality follow-back survey

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Abstract
Objectives Neonatology has undergone important clinical and legal changes; however, the implications for end-of-life decision-making in seriously ill neonates to date are unknown. Our aim was to examine changes in prevalence and characteristics of end-of-life decisions (ELDs) in neonatology. Methods We performed a nationwide mortality follow-back survey in August 1999 to July 2000 and September 2016 to December 2017 in Flanders, Belgium. Data were linked to information from death certificates. For each death under the age of 1, physicians were asked to complete an anonymous questionnaire about which ELDs were made preceding death. Results The response rate was 87% in 1999-2000 (253/292) and 83% in 2016-2017 (229/276). The proportion of deaths of infants born before 26 weeks' gestation was increased (14% vs 34%, p=0.001). Prevalence of ELDs remained stable at 60%, with non-treatment decisions occurring in about 35% of all deaths. Use of medication with an explicit life-shortening intention was prevalent in 7%-10% of all deaths. In early neonatal death (<7 days old) medication with an explicit life-shortening intention decreased from 12% to 6%, in late neonatal death (7-27 days old), it increased from 0% to 26%, and in postneonatal death (>27 days old), it increased from 2% to 10%. Conclusions Over a timespan of 17 year, the prevalence of neonatal ELDs has remained stable. A substantial number of deaths was preceded by the intentionally hastening of death by administrating medication. While surveying solely the physician perspective in this paper, there is a need for an open multidisciplinary debate, including, for example, nursing staff and family members, based on clinical as well as ethical and jurisdictional reflections to discuss the need for international guidelines.
Keywords
CARE, EUTHANASIA, CHILDREN, TRENDS, end of life care, paediatrics

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MLA
Dombrecht, Laure, et al. “End-of-Life Decisions in Neonates and Infants : A Nationwide Mortality Follow-Back Survey.” BMJ SUPPORTIVE & PALLIATIVE CARE, 2022, doi:10.1136/bmjspcare-2021-003357.
APA
Dombrecht, L., Beernaert, K., Chambaere, K., Cools, F., Goossens, L., Naulaers, G., … Deliens, L. (2022). End-of-life decisions in neonates and infants : a nationwide mortality follow-back survey. BMJ SUPPORTIVE & PALLIATIVE CARE. https://doi.org/10.1136/bmjspcare-2021-003357
Chicago author-date
Dombrecht, Laure, Kim Beernaert, Kenneth Chambaere, Filip Cools, Linde Goossens, Gunnar Naulaers, Luc Cornette, et al. 2022. “End-of-Life Decisions in Neonates and Infants : A Nationwide Mortality Follow-Back Survey.” BMJ SUPPORTIVE & PALLIATIVE CARE. https://doi.org/10.1136/bmjspcare-2021-003357.
Chicago author-date (all authors)
Dombrecht, Laure, Kim Beernaert, Kenneth Chambaere, Filip Cools, Linde Goossens, Gunnar Naulaers, Luc Cornette, Sabrina Laroche, Claire Theyskens, Christine Vandeputte, Hilde Van de Broek, Joachim Cohen, and Luc Deliens. 2022. “End-of-Life Decisions in Neonates and Infants : A Nationwide Mortality Follow-Back Survey.” BMJ SUPPORTIVE & PALLIATIVE CARE. doi:10.1136/bmjspcare-2021-003357.
Vancouver
1.
Dombrecht L, Beernaert K, Chambaere K, Cools F, Goossens L, Naulaers G, et al. End-of-life decisions in neonates and infants : a nationwide mortality follow-back survey. BMJ SUPPORTIVE & PALLIATIVE CARE. 2022;
IEEE
[1]
L. Dombrecht et al., “End-of-life decisions in neonates and infants : a nationwide mortality follow-back survey,” BMJ SUPPORTIVE & PALLIATIVE CARE, 2022.
@article{8755906,
  abstract     = {{Objectives Neonatology has undergone important clinical and legal changes; however, the implications for end-of-life decision-making in seriously ill neonates to date are unknown. Our aim was to examine changes in prevalence and characteristics of end-of-life decisions (ELDs) in neonatology. Methods We performed a nationwide mortality follow-back survey in August 1999 to July 2000 and September 2016 to December 2017 in Flanders, Belgium. Data were linked to information from death certificates. For each death under the age of 1, physicians were asked to complete an anonymous questionnaire about which ELDs were made preceding death. Results The response rate was 87% in 1999-2000 (253/292) and 83% in 2016-2017 (229/276). The proportion of deaths of infants born before 26 weeks' gestation was increased (14% vs 34%, p=0.001). Prevalence of ELDs remained stable at 60%, with non-treatment decisions occurring in about 35% of all deaths. Use of medication with an explicit life-shortening intention was prevalent in 7%-10% of all deaths. In early neonatal death (<7 days old) medication with an explicit life-shortening intention decreased from 12% to 6%, in late neonatal death (7-27 days old), it increased from 0% to 26%, and in postneonatal death (>27 days old), it increased from 2% to 10%. Conclusions Over a timespan of 17 year, the prevalence of neonatal ELDs has remained stable. A substantial number of deaths was preceded by the intentionally hastening of death by administrating medication. While surveying solely the physician perspective in this paper, there is a need for an open multidisciplinary debate, including, for example, nursing staff and family members, based on clinical as well as ethical and jurisdictional reflections to discuss the need for international guidelines.}},
  author       = {{Dombrecht, Laure and Beernaert, Kim and Chambaere, Kenneth and Cools, Filip and Goossens, Linde and Naulaers, Gunnar and Cornette, Luc and Laroche, Sabrina and Theyskens, Claire and Vandeputte, Christine and Van de Broek, Hilde and Cohen, Joachim and Deliens, Luc}},
  issn         = {{2045-435X}},
  journal      = {{BMJ SUPPORTIVE & PALLIATIVE CARE}},
  keywords     = {{CARE,EUTHANASIA,CHILDREN,TRENDS,end of life care,paediatrics}},
  language     = {{eng}},
  pages        = {{9}},
  title        = {{End-of-life decisions in neonates and infants : a nationwide mortality follow-back survey}},
  url          = {{http://dx.doi.org/10.1136/bmjspcare-2021-003357}},
  year         = {{2022}},
}

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