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Dutch neonatologists have adopted a more interventionist approach to neonatal care
Author(s) -
Koper Jan F.,
Bos Arend F.,
Janvier Annie,
Verhagen A A Eduard
Publication year - 2015
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.13050
Subject(s) - medicine , neonatal intensive care unit , referral , gestation , pediatrics , intensive care , gestational age , retrospective cohort study , neonatology , emergency medicine , pregnancy , intensive care medicine , nursing , surgery , biology , genetics
Aim This study investigated whether continuous improvements to neonatal care and the legalisation of newborn euthanasia in 2005 had changed end‐of‐life decisions by Dutch neonatologists. Methods We carried out a retrospective study of foetuses and neonates of more than 22 weeks' gestation that died in the delivery room or in the neonatal intensive care unit ( NICU ) of a tertiary referral hospital in the Netherlands, comparing end‐of‐life decisions and mortality in 2001–2003 and 2008–2010, before and after euthanasia legislation was introduced. Results In 2008–2010, there were more deaths in the delivery room due to termination of pregnancy than in 2001–2003 (17% versus 29%, p = 0.031), and fewer infants received comfort medication (12% versus 20%, p = 0.078). The main mode of death in the NICU was the withdrawal of life‐sustaining therapy. The number of days that infants lived increased significantly between 2001–2003 (11.5 days) and 2008–2010 (18.4 days, p < 0.006). Most infants received comfort medication, and neuromuscular blocking agents were administered incidentally. Conclusion Terminations increased after changes in healthcare regulations. Modes of death in the NICU remained similar over 10 years. The increased duration of NICU treatment before dying suggests a more interventionist approach to treatment in 2008–2010.