FORGOING INTENSIVE-CARE TREATMENT IN NEWBORN-INFANTS WITH EXTREMELY POOR PROGNOSES - A STUDY IN 4 NEONATAL INTENSIVE-CARE UNITS IN THE NETHERLANDS

Within the framework of the broader ethical discussion on end-of-life decision making in neonatology and the need to obtain more quantifiabl e data, we performed a multicenter study in four Dutch neonatal intens ive care units, All infants who died in these units in 1993 were inclu ded in the study, Aside from cases in which foregoing treatment was no t under discussion, cases in which death appeared inevitable (A cases) and cases in which foregoing treatment because of extremely poor prog nosis was the decisive factor (B cases) were distinguished, A total of 181 neonatal deaths occurred, Thirty-five infants died even after ful l continuation of treatment. In 98 A cases and 48 B cases, which toget her represented 81% of all deaths, treatment was foregone either becau se the infants had no chance to survive or because of extremely poor p rognoses, In these cases, the medical team ultimately achieved consens us of opinion, although in some instances several sessions were requir ed, In three cases, the parents did not agree with the team advice, In one A case death appeared inevitable. In two B cases, the parents' wi sh to continue treatment was followed. In a large majority of B cases, the decisions to forego treatment were based on the presence of sever e cerebral damage, In A cases there was no real choice because death a ppeared inevitable. However, in B cases neonatologists were obliged to determine whether continuation of treatment was justifiable or if wit hdrawal of treatment in view of extremely poor prognoses was preferred .