Center, Gestational Age, and Race Impact End-of-Life Care Practices at Regional Neonatal Intensive Care Units

• Published in: The Journal of pediatrics 2020-02, Vol.217, p.86-91.e1
• Main Authors: Fry, Jessica T., Matoba, Nana, Datta, Ankur, DiGeronimo, Robert, Coghill, Carl H., Natarajan, Girija, Brozanski, Beverly, Leuthner, Steven R., Niehaus, Jason Z., Schlegel, Amy Brown, Shah, Anita, Zaniletti, Isabella, Bartman, Thomas, Murthy, Karna, Sullivan, Kevin M., Asselin, Jeanette, Durand, David, Dykes, Francine, Evans, Jacquelyn, Padula, Michael, Pallotto, Eugenia, Grover, Theresa, Piazza, Anthony, Reber, Kristina, Short, Billie
• Format: Article
• Language: English
• Subjects: Children's Hospitals Neonatal Consortium; Children's Hospitals Neonatal Database; end-of-life care; neonatal death; neonatal intensive care
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2019.10.039

To assess the impact of intercenter variation and patient factors on end-of-life care practices for infants who die in regional neonatal intensive care units (NICUs). We conducted a retrospective cohort analysis using the Children's Hospital Neonatal Database during 2010-2016. A total of 6299 nonsurviving infants cared for in 32 participating regional NICUs were included to examine intercenter variation and the effects of gestational age, race, and cause of death on 3 end-of-life care practices: do not attempt resuscitation orders (DNR), cardiopulmonary resuscitation within 6 hours of death (CPR), and withdrawal of life-sustaining therapies (WLST). Factors associated with these practices were used to develop a multivariable equation. Dying infants in the cohort underwent DNR (55%), CPR (21%), and WLST (73%). Gestational age, cause of death, and race were significantly and differently associated with each practice: younger gestational age (