Page 9 - American Nurse Today January 2008

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deaths in an intensive care nursery (ICN) and to determine the reasons documented by neonatologists for the decisions to withdraw or with- hold life support. The descriptive study was based on a review of the medical records of infants who died at a university-based level III ICN during a 3-year period.
The study found that of the 1,609 infants admitted, 165 died. Of the 165 deaths, 108 followed the with- drawal of life support, 13 followed the withholding of treatment, and 44 occurred during maximum life-sus- taining treatment. For 90 (74%) of the 121 deaths from withholding or withdrawing treatment, physicians cited death as imminent and treat- ment as futile. However, quality-of- life concerns were cited as reasons to limit treatment in 62 (51%) of the cases. And quality of life was the only reason cited for limiting treatment for 28 (23%) of the 121 deaths attributed to withholding or withdrawing treatment.
The researchers concluded that most deaths in the ICN resulted from selective non-treatment. Neonatologists often documented that quality-of-life concerns were considered in decisions to limit treatment, even though the majority of these decisions were based on the belief that treatment was futile.
Palliative care for
dying neonates
A 2003 Institute of Medicine report, “When Children Die: Improving Palliative and End-of-Life Care for Children and Their Families,” says that 34% of childhood deaths occur in the neonatal period. Of course, most occur in the neonatal inten- sive care unit (NICU). (See Starting palliative care in the NICU.)
The fact that an infant is dying doesn’t change the focus of care for NICU nurses and physicians. They still act in the patient’s best interest. NICU nurses work hard to create an environment that pro- vides high-tech and high-touch,
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American Nurse Today 9
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