Decision making and modes of death in a tertiary neonatal unit

Aims: To study the frequency and reason for withdrawal/ withholding of life sustaining treatment (LST) and do not resuscitate (DNR) orders in infants who died in a tertiary neonatal unit. Methods: Infants who died at Homerton University Hospital between January 1998 and September 2001 were studied by retrospective analysis of patient records. Results: The case notes of 71 (84%) of 85 infants who died were studied. Mode of death was withdrawal of LST in 28 (40%), DNR in 11 (15%), withholding of LST in two (3%), and natural in 30 (42%) infants. Withdrawal of LST was discussed with the parents of 39 seriously ill infants; 28 (72%) parents agreed. There was no difference in birth weight and gestational age of babies whose parents agreed or refused withdrawal of LST. White and Afro-Caribbean parents and those from the Indian subcontinent ( 20 of 23) were more likely to agree to withdrawal of LST than Black African or Jewish ( eight of 16, p = 0.015) parents. The median age at withdrawal of LST was 4 days ( range 1 - 57). The median duration between discussion and the parents agreeing to withdrawal of LST was 165 minutes ( range 30 - 2160), and median duration between withdrawal of LST and death was 22 minutes ( range 5 - 210). The most common reason for withdrawal of LST was complications of extreme prematurity (68%). Conclusion: The most common mode of death was withdrawal of LST, and the most common reason was complications of extreme prematurity. The ethnic and cultural background of the parents influenced agreement to withdrawal of LST.