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BMJ Open. 2017 Jun 15;7(6):e015179. doi: 10.1136/bmjopen-2016-015179.

Retrospective cohort study of all deaths among infants born between 22 and 27 completed weeks of gestation in Switzerland over a 3-year period.

Author information

1
Neonatal and Paediatric Intensive Care Unit, Children's Hospital Lucerne, Lucerne, Switzerland.
2
Division of Pediatric Critical Care, Department of Pediatrics, University of California Medical Center, San Francisco, California, USA.
3
Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
4
Division of Neonatology and Paediatric Intensive Care, Children's University Hospital Geneva, Geneva, Switzerland.
5
Dialogue Ethics Foundation, Interdisciplinary Institute for Ethics in Health Care, Zurich, Switzerland.

Abstract

OBJECTIVES:

The aim of this research is to assess causes and circumstances of deaths in extremely low gestational age neonates (ELGANs) born in Switzerland over a 3-year period.

DESIGN:

Population-based, retrospective cohort study.

SETTING:

All nine level III perinatal centres (neonatal intensive care units (NICUs) and affiliated obstetrical services) in Switzerland.

PATIENTS:

ELGANs with a gestational age (GA) <28 weeks who died between 1 July 2012 and 30 June 2015.

RESULTS:

A total of 594 deaths were recorded with 280 (47%) stillbirths and 314 (53%) deaths after live birth. Of the latter, 185 (59%) occurred in the delivery room and 129 (41%) following admission to an NICU. Most liveborn infants dying in the delivery room had a GA ≤24 weeks and died following primary non-intervention. In contrast, NICU deaths occurred following unrestricted life support regardless of GA. End-of-life decision-making and redirection of care were based on medical futility and anticipated poor quality of life in 69% and 28% of patients, respectively. Most infants were extubated before death (87%).

CONCLUSIONS:

In Switzerland, most deaths among infants born at less than 24 weeks of gestation occurred in the delivery room. In contrast, most deaths of ELGANs with a GA ≥24 weeks were observed following unrestricted provisional intensive care, end-of-life decision-making and redirection of care in the NICU regardless of the degree of immaturity.

KEYWORDS:

end-of-life decision-making; extremely low gestational age neonates; live birth; redirection of care; stillbirth

PMID:
28619775
PMCID:
PMC5734457
DOI:
10.1136/bmjopen-2016-015179
[Indexed for MEDLINE]
Free PMC Article

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