Withholding and withdrawal of life support from surgical neonates with life-threatening congenital anomalies.
J Pediatr Surg
; 28(9): 1093-7, 1993 Sep.
Article
em En
| MEDLINE
| ID: mdl-8308667
ABSTRACT
We evaluated why and how life support was withheld or withdrawn in surgical neonates. During the study period, January 1988 through December 1991, 529 neonates were admitted, 52 of whom died (10%). Twenty-eight deaths were due to the underlying disease. The other 24 patients died because treatment was withheld or withdrawn. In 15 of 24 (group A, mean stay 9.2 +/- 9.1 days) treatment was initially started but later withdrawn (13/15) because of the severity of congenital anomalies alone (7/12) or congenital anomalies associated with chromosomal anomalies (5/12). In 9 of 24 (group B, mean stay 20.3 +/- 17.3 days) treatment was withdrawn because of serious complications. In all cases often lengthy discussions have led the doctors and nurses together with the parents to chose unanimously for withdrawal of treatment. Mechanical ventilation was the intervention most frequently withdrawn (10/15 group A, 9/9 group B). Vasoactive and other drugs were withheld in 5 patients of group A. Sedatives and analgetics were administrated as supportive care permitting the child to die in a humane way, 17 in the lap of a parent and 7 in the lap of a nurse. We conclude that life-sustaining care is withheld or withdrawn relatively frequently from patients at our ICU. Such decisions are ethical ones, taken in the light of professional and technical expertise. Evaluation of withholding or withdrawal of treatment is difficult but necessary to evolve appropriate decision-making procedures and to formulate humane standards of intensive care.(ABSTRACT TRUNCATED AT 250 WORDS)
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Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Anormalidades Múltiplas
/
Eutanásia Passiva
/
Suspensão de Tratamento
/
Hospitais Pediátricos
/
Cuidados para Prolongar a Vida
Tipo de estudo:
Guideline
/
Prognostic_studies
Limite:
Humans
/
Newborn
País/Região como assunto:
Europa
Idioma:
En
Revista:
J Pediatr Surg
Ano de publicação:
1993
Tipo de documento:
Article
País de afiliação:
Holanda