NO RESUSCITATION AND WITHDRAWAL OF THERAPY IN A NEONATAL AND A PEDIATRIC INTENSIVE-CARE UNIT IN CANADA

Study objective: To compare and contrast the modes of death in a neona tal (NICU) and a pediatric (PICU) intensive care unit. Design: Retrosp ective analysis of patient records. Subjects: All newborn infants and children (<17 years of age) who died in the NICU and PICU at the Unive rsity of Alberta Hospitals, Edmonton, between Jan. 1, 1990, to Dec. 31 , 1991. Results: The mortality rate in the PICU was 8.7% (73/839) comp ared with 5.6% (75/1333) in the NICU (p = 0.007). Withdrawal of therap y was the most common cause of death in both units and occurred more c ommonly in the NICU (NICU = 69% vs PICU = 34%; p = 0.01). There were s ignificantly more deaths as a result of failed cardiopulmonary resusci tation (CPR) in the PICU than in the NICU (29% vs 13%; p = 0.046). Dea th after no-CPR orders occurred with equal frequency in both units (NI CU 17%; PICU 15%). Brain death accounted for 22% (16/87) of PICU death s; no infant in the NICU was declared brain dead (p <0.05). When death s resulting from brain death and failed CPR were excluded, there was n o 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 an d 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.