The following is a summary of “Complex end-of-life decision-making during neonatal retrieval: A retrospective cohort study,” published in the October 2024 issue of Pediatrics by Cantelmi et al.
Complex end-of-life decision-making in neonatal care can impact patient outcomes, particularly in cases of prematurity and hypoxic-ischemic encephalopathy (HIE).
Researchers conducted a retrospective study comparing infants who were palliated before transfer to those who were palliated after transfer within 7 days of birth.
They analyzed infants referred to the neonatal retrieval service between December 1, 2015, and March 31, 2022, who died during retrieval or within 7 days of referral.
The results showed that 25 (42%) infants were not transported and were palliated, while 35 (58%) infants were transported and further palliated at the hospital. Prematurity (42%) and HIE (42%) were primary diagnoses. Infants palliated at the referring hospital required resuscitation, including chest compressions more often (52% vs. 23%, P=0.02), management for hypotension (72% vs. 20%, P<0.001), and management for pneumothorax (28% vs. 0%, P=0.001) and were less likely to need management for seizures (8% vs. 43%, P=0.003).
They concluded that palliation at the referring hospital should be considered when escalation of care was unlikely to improve outcomes, as infants requiring transport often needed significant management during stabilization.
Source: onlinelibrary.wiley.com/doi/abs/10.1111/jpc.16696
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