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Doctors Keeping Very Sick Babies Off Life Support | Daytona Beach Child Injury Lawyer

Doctors Keeping Very Sick Babies Off Life Support

A new study of babies in intensive care suggests that doctors are getting better at recognizing situations where infants are sure to die or have severe brain damage — and are often holding back on life support when that’s the case.

“Currently, most childhood deaths in the United States occur during the neonatal period and most neonatal deaths follow a decision to withhold or withdraw life-sustaining treatment,” the authors write as background information in the article published in the Archives of Pediatrics & Adolescent Medicine. Indeed, about six of every 1,000 infants die in the U.S. before their first birthday — with more than half of those deaths coming in the first 28 days.

Prior studies, conducted in the previous 30 years have shown that an increasing number of parents forgo life-sustaining treatment near the end of their child’s life, and the number of children with do-not-resuscitate (DNR) orders also increased.

Dr. Julie Weiner of Children’s Mercy Hospital in Kansas City, Mo., and colleagues examined medical records of 414 infants who died between January 1999 and December 2008 at a regional referral neonatal intensive care unit to determine if trends towards decreasing use of cardiopulmonary resuscitation (CPR) at the end-of-life for infants in neonatal intensive care units (NICU) had continued into present day.

Of the 414 infant deaths included in the study, 45 percent were due to major congenital anomalies (also known as birth defects; a physical anomaly that has cosmetic or functional significance), 17 percent of these infants were very preterm. Thirty-five percent of deaths were of very preterm births without congenital birth defects.

But the researchers were more interested in how those babies died — whether it was while doctors were trying to save or prolong their lives, or whether babies had been taken off ventilators, feeding tubes, and other life support when doctors realized there was nothing more they could do.

During the ten-year follow-up period, 61.6 percent of infant deaths followed withdrawal of treatment, 20.8 percent followed withholding of treatment and 17.6 percent died despite attempted CPR.

The percentage of deaths that followed withholding of life-sustaining treatment also increased by an average of 1.03 deaths per year during the study’s follow-up period. Most of this change was accounted for in very preterm infants (32 weeks or less gestation).

For very preterm infants, deaths following withheld treatment increased by 0.7 per year, and during the study follow-up period, withholding of care significantly increased from less than 10 percent to more than 30 percent. Additionally, the use of CPR at death tended to decrease during the same time period.

The study also suggested that parents have become more involved in discussing end-of-life options.

“For parents it’s overwhelming anyway to be in the (neonatal intensive care unit), and to have an infant that is dying — nobody expects to have a baby that’s going to die,” Weiner said in a news release. “Our hope when we do provide end-of-life care is trying to provide compassionate loving, care to … our families and our dying neonates.”

For more on child medical issues, see the library of articles by Daytona Beach child injury attorney.



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