ANALGESIA FOR DYING INFANTS WHOSE LIFE-SUPPORT IS WITHDRAWN OR WITHHELD

Objective. To determine the frequency of opiate analgesia administrati on to infants when life support is discontinued and to determine wheth er infant characteristics, such as birth weight and diagnosis, or the physician's reasons for discontinuing life support influence either th e decision to provide opioid agents or the dosages administered. Metho ds. We reviewed all 165 deaths in a 3-year period at a university-base d level III intensive care nursery. Of the 121 deaths attributable to withdrawal or withholding of mechanical ventilation and/or extracorpor eal membrane oxygenation, we ascertained whether opioid analgesics (mo rphine sulfate [MSI or fentanyl) were administered either concurrent w ith or after life-support withdrawal and at what doses. We examined wh ether these end-of-life practices varied according to birth weight, di agnoses, and the reasons documented by the neonatologist for discontin uing life support. Results. Opioid analgesia was provided to 84% of in fants as their life support was either withheld or withdrawn. Infants with necrotizing enterocolitis and major anomalies or chromosomal diso rders were more likely to be given opiates than infants with other dia gnoses. Birth weight was not different for infants who received opiate s compared with those who were not given opiates. Opioid analgesia was provided to all 18 infants for whom physicians documented the patient s' suffering as a reason to discontinue life support. Sixty-four perce nt of infants who received opiates were given doses in the usual pharm acologic range of 0.1 to 0.2 mg/kg MS. Of the 36 infants given more th an 0.2 mg/kg MS, all but 2 were receiving ongoing treatment with opioi d agents. Conculsions. In most cases of withholding or withdrawal, of life support in critically ill infants, neonatologists provided opioid analgesia to these infants at the end of Life, despite the potential respiratory depression of opioid agents in infants whose respiratory s upport is discontinued.