Circumstances of dying in hospitalized children

Conditions of dying in a tertiary children's hospital were assessed in a re trospective cohort study. Non-survivors, excluding newborns and emergency r oom patients, were allocated to four groups: brain death (BD), failed cardi opulmonary resuscitation (failed CPR), death following a do-not-resuscitate (DNR) order and death following withholding or withdrawal of therapy (W/W) . In a 4-year period 190 (1.3%) of 14,903 admitted patients died. Of these 134 (71%) died on the paediatric intensive care unit, 42 (22%) on the ward and 14 (7%) in the operating room. W/W was found in 75 (39%), failed CPR in 57 (30%), ED in 32 (17%), and death following a DNR. order in 26 (14%). Ju stifications for restrictions of treatment (W/W or DNR) were imminent death in 41 (41%), lack of future relational potential in 13 (13%) and excessive burden of disease in 47 (47%). In non-survivors analgesics and sedatives w ere frequently used to relieve suffering in the terminal phase. General pri nciples for the approach of terminally ill children in whom death may becom e an option instead of a fate are discussed. Conclusion In the majority of children dying in hospital, death occurred fo llowing restrictions of life-sustaining treatment; comprising do-not-resusc itate or other forms of withholding or withdrawal of therapy.