Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objectives To describe the frequency of postnatal discussions about withdrawal or withholding of life-sustaining therapy (WWLST), ensuing WWLST, and outcomes of infants surviving such discussions. We hypothesized that such survivors have poor outcomes. Study design This retrospective review included registry data from 18 centers of the National Institute of Child Health and Human Development Neonatal Research Network. Infants born at 22-28 weeks of gestation who survived >12 hours during 2011-2013 were included. Regression analysis identified maternal and infant factors associated with WWLST discussions and factors predicting ensuing WWLST. In-hospital and 18- to 26-month outcomes were evaluated. Results WWLST discussions occurred in 529 (15.4%) of 3434 infants. These were more frequent at 22-24 weeks (27.0%) compared with 27-28 weeks of gestation (5.6%). Factors associated with WWLST discussion were male sex, gestational age (GA) of ≤24 weeks, birth weight small for GA, congenital malformations or syndromes, early onset sepsis, severe brain injury, and necrotizing enterocolitis. Rates of WWLST discussion varied by center (6.4%-29.9%) as did WWLST (5.2%-20.7%). Ensuing WWLST occurred in 406 patients; of these, 5 survived to discharge. Of the 123 infants for whom intensive care was continued, 58 (47%) survived to discharge. Survival after WWLST discussion was associated with higher rates of neonatal morbidities and neurodevelopmental impairment compared with babies for whom WWLST discussions did not occur. Significant predictors of ensuing WWLST were maternal age >25 years, necrotizing enterocolitis, and days on a ventilator. Conclusions Wide center variations in WWLST discussions occur, especially at ≤24 weeks GA. Outcomes of infants surviving after WWLST discussions are poor. Trial registration ClinicalTrials.gov: NCT00063063.

Original languageEnglish (US)
Pages (from-to)118-123.e4
JournalJournal of Pediatrics
Volume190
DOIs
StatePublished - Nov 1 2017
Externally publishedYes

Fingerprint

Premature Infants
Therapeutics
Gestational Age
Necrotizing Enterocolitis
National Institute of Child Health and Human Development (U.S.)
Pregnancy
Maternal Age
Mechanical Ventilators
Critical Care
Birth Weight
Brain Injuries
Survivors
Registries
Sepsis
Regression Analysis
Mothers

Keywords

  • disability
  • ethics
  • newborn
  • palliative care
  • prognosis

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (2017). Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support. Journal of Pediatrics, 190, 118-123.e4. https://doi.org/10.1016/j.jpeds.2017.05.056

Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support. / Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.

In: Journal of Pediatrics, Vol. 190, 01.11.2017, p. 118-123.e4.

Research output: Contribution to journalArticle

Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network 2017, 'Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support', Journal of Pediatrics, vol. 190, pp. 118-123.e4. https://doi.org/10.1016/j.jpeds.2017.05.056
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support. Journal of Pediatrics. 2017 Nov 1;190:118-123.e4. https://doi.org/10.1016/j.jpeds.2017.05.056
Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. / Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support. In: Journal of Pediatrics. 2017 ; Vol. 190. pp. 118-123.e4.
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abstract = "Objectives To describe the frequency of postnatal discussions about withdrawal or withholding of life-sustaining therapy (WWLST), ensuing WWLST, and outcomes of infants surviving such discussions. We hypothesized that such survivors have poor outcomes. Study design This retrospective review included registry data from 18 centers of the National Institute of Child Health and Human Development Neonatal Research Network. Infants born at 22-28 weeks of gestation who survived >12 hours during 2011-2013 were included. Regression analysis identified maternal and infant factors associated with WWLST discussions and factors predicting ensuing WWLST. In-hospital and 18- to 26-month outcomes were evaluated. Results WWLST discussions occurred in 529 (15.4{\%}) of 3434 infants. These were more frequent at 22-24 weeks (27.0{\%}) compared with 27-28 weeks of gestation (5.6{\%}). Factors associated with WWLST discussion were male sex, gestational age (GA) of ≤24 weeks, birth weight small for GA, congenital malformations or syndromes, early onset sepsis, severe brain injury, and necrotizing enterocolitis. Rates of WWLST discussion varied by center (6.4{\%}-29.9{\%}) as did WWLST (5.2{\%}-20.7{\%}). Ensuing WWLST occurred in 406 patients; of these, 5 survived to discharge. Of the 123 infants for whom intensive care was continued, 58 (47{\%}) survived to discharge. Survival after WWLST discussion was associated with higher rates of neonatal morbidities and neurodevelopmental impairment compared with babies for whom WWLST discussions did not occur. Significant predictors of ensuing WWLST were maternal age >25 years, necrotizing enterocolitis, and days on a ventilator. Conclusions Wide center variations in WWLST discussions occur, especially at ≤24 weeks GA. Outcomes of infants surviving after WWLST discussions are poor. Trial registration ClinicalTrials.gov: NCT00063063.",
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author = "{Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network} and Jennifer James and David Munson and DeMauro, {Sara B.} and Langer, {John C.} and Dworetz, {April R.} and Girija Natarajan and Margarita Bidegain and Fortney, {Christine A.} and Ruth Seabrook and Vohr, {Betty R.} and Tyson, {Jon E.} and Bell, {Edward F.} and Poindexter, {Brenda B.} and Seetha Shankaran and Higgins, {Rosemary D.} and Abhik Das and Stoll, {Barbara J.} and Haresh Kirpalani and Caplan, {Michael S.} and Laptook, {Abbot R.} and Hensman, {Angelita M.} and Elisa Vieira and Emilee Little and Robert Burke and Melinda Caskey and Katharine Johnson and Barbara Alksninis and Keszler, {Mary Lenore} and Knoll, {Andrea M.} and Leach, {Theresa M.} and McGowan, {Elisabeth C.} and Watson, {Victoria E.} and Suzy Ventura and Walsh, {Michele C.} and Fanaroff, {Avroy A.} and Hibbs, {Anna Marie} and Newman, {Nancy S.} and Payne, {Allison H.} and Wilson-Costello, {Deanne E.} and Siner, {Bonnie S.} and Monika Bhola and Gulgun Yalcinkaya and Friedman, {Harriet G.} and Truog, {William E.} and Pallotto, {Eugenia K.} and Kilbride, {Howard W.} and Cheri Gauldin and Anne Holmes and Kathy Johnson and Satyanarayana Lakshminrusimha",
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T1 - Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support

AU - Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

AU - James, Jennifer

AU - Munson, David

AU - DeMauro, Sara B.

AU - Langer, John C.

AU - Dworetz, April R.

AU - Natarajan, Girija

AU - Bidegain, Margarita

AU - Fortney, Christine A.

AU - Seabrook, Ruth

AU - Vohr, Betty R.

AU - Tyson, Jon E.

AU - Bell, Edward F.

AU - Poindexter, Brenda B.

AU - Shankaran, Seetha

AU - Higgins, Rosemary D.

AU - Das, Abhik

AU - Stoll, Barbara J.

AU - Kirpalani, Haresh

AU - Caplan, Michael S.

AU - Laptook, Abbot R.

AU - Hensman, Angelita M.

AU - Vieira, Elisa

AU - Little, Emilee

AU - Burke, Robert

AU - Caskey, Melinda

AU - Johnson, Katharine

AU - Alksninis, Barbara

AU - Keszler, Mary Lenore

AU - Knoll, Andrea M.

AU - Leach, Theresa M.

AU - McGowan, Elisabeth C.

AU - Watson, Victoria E.

AU - Ventura, Suzy

AU - Walsh, Michele C.

AU - Fanaroff, Avroy A.

AU - Hibbs, Anna Marie

AU - Newman, Nancy S.

AU - Payne, Allison H.

AU - Wilson-Costello, Deanne E.

AU - Siner, Bonnie S.

AU - Bhola, Monika

AU - Yalcinkaya, Gulgun

AU - Friedman, Harriet G.

AU - Truog, William E.

AU - Pallotto, Eugenia K.

AU - Kilbride, Howard W.

AU - Gauldin, Cheri

AU - Holmes, Anne

AU - Johnson, Kathy

AU - Lakshminrusimha, Satyanarayana

PY - 2017/11/1

Y1 - 2017/11/1

N2 - Objectives To describe the frequency of postnatal discussions about withdrawal or withholding of life-sustaining therapy (WWLST), ensuing WWLST, and outcomes of infants surviving such discussions. We hypothesized that such survivors have poor outcomes. Study design This retrospective review included registry data from 18 centers of the National Institute of Child Health and Human Development Neonatal Research Network. Infants born at 22-28 weeks of gestation who survived >12 hours during 2011-2013 were included. Regression analysis identified maternal and infant factors associated with WWLST discussions and factors predicting ensuing WWLST. In-hospital and 18- to 26-month outcomes were evaluated. Results WWLST discussions occurred in 529 (15.4%) of 3434 infants. These were more frequent at 22-24 weeks (27.0%) compared with 27-28 weeks of gestation (5.6%). Factors associated with WWLST discussion were male sex, gestational age (GA) of ≤24 weeks, birth weight small for GA, congenital malformations or syndromes, early onset sepsis, severe brain injury, and necrotizing enterocolitis. Rates of WWLST discussion varied by center (6.4%-29.9%) as did WWLST (5.2%-20.7%). Ensuing WWLST occurred in 406 patients; of these, 5 survived to discharge. Of the 123 infants for whom intensive care was continued, 58 (47%) survived to discharge. Survival after WWLST discussion was associated with higher rates of neonatal morbidities and neurodevelopmental impairment compared with babies for whom WWLST discussions did not occur. Significant predictors of ensuing WWLST were maternal age >25 years, necrotizing enterocolitis, and days on a ventilator. Conclusions Wide center variations in WWLST discussions occur, especially at ≤24 weeks GA. Outcomes of infants surviving after WWLST discussions are poor. Trial registration ClinicalTrials.gov: NCT00063063.

AB - Objectives To describe the frequency of postnatal discussions about withdrawal or withholding of life-sustaining therapy (WWLST), ensuing WWLST, and outcomes of infants surviving such discussions. We hypothesized that such survivors have poor outcomes. Study design This retrospective review included registry data from 18 centers of the National Institute of Child Health and Human Development Neonatal Research Network. Infants born at 22-28 weeks of gestation who survived >12 hours during 2011-2013 were included. Regression analysis identified maternal and infant factors associated with WWLST discussions and factors predicting ensuing WWLST. In-hospital and 18- to 26-month outcomes were evaluated. Results WWLST discussions occurred in 529 (15.4%) of 3434 infants. These were more frequent at 22-24 weeks (27.0%) compared with 27-28 weeks of gestation (5.6%). Factors associated with WWLST discussion were male sex, gestational age (GA) of ≤24 weeks, birth weight small for GA, congenital malformations or syndromes, early onset sepsis, severe brain injury, and necrotizing enterocolitis. Rates of WWLST discussion varied by center (6.4%-29.9%) as did WWLST (5.2%-20.7%). Ensuing WWLST occurred in 406 patients; of these, 5 survived to discharge. Of the 123 infants for whom intensive care was continued, 58 (47%) survived to discharge. Survival after WWLST discussion was associated with higher rates of neonatal morbidities and neurodevelopmental impairment compared with babies for whom WWLST discussions did not occur. Significant predictors of ensuing WWLST were maternal age >25 years, necrotizing enterocolitis, and days on a ventilator. Conclusions Wide center variations in WWLST discussions occur, especially at ≤24 weeks GA. Outcomes of infants surviving after WWLST discussions are poor. Trial registration ClinicalTrials.gov: NCT00063063.

KW - disability

KW - ethics

KW - newborn

KW - palliative care

KW - prognosis

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