Jessica T Fry1, Nana Matoba2, Ankur Datta2, Robert DiGeronimo3, Carl H Coghill4, Girija Natarajan5, Beverly Brozanski6, Steven R Leuthner7, Jason Z Niehaus8, Amy Brown Schlegel9, Anita Shah10, Isabella Zaniletti11, Thomas Bartman9, Karna Murthy2, Kevin M Sullivan12. 1. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Neonatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. Electronic address: jtfry@luriechildrens.org. 2. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Division of Neonatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 3. Department of Pediatrics, University of Washington, Seattle, WA; Division of Neonatology, Seattle Children's Hospital, Seattle, WA. 4. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL; Division of Neonatology, Children's of Alabama, Birmingham, AL. 5. Department of Pediatrics, Wayne State University, Detroit, MI; Division of Neonatology, Children's Hospital of Michigan, Detroit, MI. 6. Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA; Division of Newborn Medicine, UPMC Children's Hospital, Pittsburgh, PA. 7. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI; Division of Neonatology, Children's Hospital of Wisconsin, Milwaukee, WI. 8. Department of Pediatrics, Indiana University, Indianapolis, IN; Division of Neonatology, Riley Hospital for Children, Indianapolis, IN. 9. Department of Pediatrics, The Ohio State College of Medicine, Columbus, OH; Division of Neonatology, Nationwide Children's Hospital, Columbus, OH. 10. Division of Neonatology, Children's Hospital of Orange County, Orange, CA. 11. Children's Hospitals Association, Lenexa, KS. 12. Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA; Division of Neonatology, Nemours/AI duPont Hospital for Children, Wilmington, DE.
Abstract
OBJECTIVE: To assess the impact of intercenter variation and patient factors on end-of-life care practices for infants who die in regional neonatal intensive care units (NICUs). STUDY DESIGN: We conducted a retrospective cohort analysis using the Children's Hospital Neonatal Database during 2010-2016. A total of 6299 nonsurviving infants cared for in 32 participating regional NICUs were included to examine intercenter variation and the effects of gestational age, race, and cause of death on 3 end-of-life care practices: do not attempt resuscitation orders (DNR), cardiopulmonary resuscitation within 6 hours of death (CPR), and withdrawal of life-sustaining therapies (WLST). Factors associated with these practices were used to develop a multivariable equation. RESULTS: Dying infants in the cohort underwent DNR (55%), CPR (21%), and WLST (73%). Gestational age, cause of death, and race were significantly and differently associated with each practice: younger gestational age (<28 weeks) was associated with CPR (OR 1.7, 95% CI 1.5-2.1) but not with DNR or WLST, and central nervous system injury was associated with DNR (1.6, 1.3-1.9) and WLST (4.8, 3.7-6.2). Black race was associated with decreased odds of WLST (0.7, 0.6-0.8). Between centers, practices varied widely at different gestational ages, race, and causes of death. CONCLUSIONS: From the available data on end-of-life care practices for regional NICU patients, variability appears to be either individualized or without consistency.
OBJECTIVE: To assess the impact of intercenter variation and patient factors on end-of-life care practices for infants who die in regional neonatal intensive care units (NICUs). STUDY DESIGN: We conducted a retrospective cohort analysis using the Children's Hospital Neonatal Database during 2010-2016. A total of 6299 nonsurviving infants cared for in 32 participating regional NICUs were included to examine intercenter variation and the effects of gestational age, race, and cause of death on 3 end-of-life care practices: do not attempt resuscitation orders (DNR), cardiopulmonary resuscitation within 6 hours of death (CPR), and withdrawal of life-sustaining therapies (WLST). Factors associated with these practices were used to develop a multivariable equation. RESULTS: Dying infants in the cohort underwent DNR (55%), CPR (21%), and WLST (73%). Gestational age, cause of death, and race were significantly and differently associated with each practice: younger gestational age (<28 weeks) was associated with CPR (OR 1.7, 95% CI 1.5-2.1) but not with DNR or WLST, and central nervous system injury was associated with DNR (1.6, 1.3-1.9) and WLST (4.8, 3.7-6.2). Black race was associated with decreased odds of WLST (0.7, 0.6-0.8). Between centers, practices varied widely at different gestational ages, race, and causes of death. CONCLUSIONS: From the available data on end-of-life care practices for regional NICU patients, variability appears to be either individualized or without consistency.
Authors: Markita Suttle; Mark W Hall; Murray M Pollack; Robert A Berg; Patrick S McQuillen; Peter M Mourani; Anil Sapru; Joseph A Carcillo; Emily Startup; Richard Holubkov; J Michael Dean; Daniel A Notterman; Kathleen L Meert Journal: Pediatr Crit Care Med Date: 2021-04-01 Impact factor: 3.971