MSC Wong, BCC Lam

Abstract

Purpose: To identify the different causes of neonatal death and the proportion preceded by end of life decision. To review the end of life practice including consensus building, comfort care program, bereavement support and autopsy in our neonatal unit. Methods: A retrospective chart review on infants died in the neonatal care unit in Queen Mary Hospital in the period between July 1998 to October 2002. Findings: During the study period, there were a total of 793 neonatal intensive care admissions with 40 deaths. Among these 40 death cases, 28 (70%) deaths were preceded by end of life decision with futile treatment (54%) and poor quality of life (46%) as the motives. The end of life decision was followed by withdrawal and withholding support in 43% and 57% respectively. Sixty-eight percent of end of life group received opioid analgesia for pain relief, sedation or respiratory distress. The median time between withdrawal and death was 2.75 hours (range from 3 minutes to 28 hours). Forty-five percent of our patients had postmortem or paramortem examination. Conclusion: With advancement of neonatal intensive care technology, similar to most modern neonatal intensive care units, majority of our neonatal deaths were preceded by end of life decision. The decision was mostly based on futility of treatment or quality of life issues. Consensus building within the management team and parental involvement is of utmost importance. Adequate analgesia and comprehensive care including comfort care, provision of private environment, family and bereavement support are essential.