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J Pediatr. 1993 Oct;123(4):534-8.

No resuscitation and withdrawal of therapy in a neonatal and a pediatric intensive care unit in Canada.

Author information

1
Neonatal Intensive Care Unit, University of Alberta Hospital, Edmonton, Canada.

Abstract

STUDY OBJECTIVE:

To compare and contrast the modes of death in a neonatal (NICU) and a pediatric (PICU) intensive care unit.

DESIGN:

Retrospective analysis of patient records.

SUBJECTS:

All newborn infants and children (< 17 years of age) who died in the NICU and PICU at the University of Alberta Hospitals, Edmonton, between Jan. 1, 1990, to Dec. 31, 1991.

RESULTS:

The mortality rate in the PICU was 8.7% (73/839) compared with 5.6% (75/1333) in the NICU (p = 0.007). Withdrawal of therapy was the most common cause of death in both units and occurred more commonly in the NICU (NICU = 69% vs PICU = 34%; p = 0.01). There were significantly more deaths as a result of failed cardiopulmonary resuscitation (CPR) in the PICU than in the NICU (29% vs 13%; p = 0.046). Death after no-CPR orders occurred with equal frequency in both units (NICU 17%; PICU 15%). Brain death accounted for 22% (16/87) of PICU deaths; no infant in the NICU was declared brain dead (p < 0.05). When deaths resulting from brain death and failed CPR were excluded, there was no significant difference between the two units regarding withdrawal of therapy (NICU 80% vs PICU 69%) and no-CPR orders (NICU 20% vs PICU 30%).

CONCLUSIONS:

This study confirms that both withdrawal of therapy and no-CPR orders are part of current clinical practice in both the NICU and PICU settings. The ethical foundations and implications of these practices need further elaboration.

PMID:
8410503
[Indexed for MEDLINE]

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