Identifying futility in a neonatal intensive care unit setting

Caring for infants born with lesions that are either incompatible with life or conditions that will not allow meaningful survival is an ethical dilemma. Provision of intensive ineffective care to these infants may be labeled as "futile care" which can consume a major proportion of total hospital expenditure. We conducted the present study to look at the extent of futility in a neonatal intensive care unit (NICU) setting. All neonates with lesion either incompatible with life or conditions that will not allow meaningful survival admitted during April 2003 to September 2003 in the Neonatal Intensive Care Unit, Royal Hospital, Muscat, Sultanate of Oman, were reviewed to identify futility. Bed days were used as surrogate for extent of futile care and resource consumption. A total of 355 infants were admitted to the NICU during the study period representing 4452 consecutive patient bed days. Twenty-five infants fulfilled the criteria of futility. Total length of stay of futile group was 317 (7.1%) days as compared to 4153 (92.8%) days in the non-futile group. The bed occupancy for futile care cases was less than 8% of all the NICU beds suggesting only a small proportion of resource consumption. Based on this, expecting cost savings from further limiting futile care in neonates is not warranted and is negligible. Ethically, we are assured that the majority of the care provided to our sick neonates are appropriate.