Center, Gestational Age, and Race Impact End-of-Life Care Practices at Regional Neonatal Intensive Care Units
To assess the impact of intercenter variation and patient factors on end-of-life care practices for infants who die in regional neonatal intensive care units (NICUs). We conducted a retrospective cohort analysis using the Children's Hospital Neonatal Database during 2010-2016. A total of 6299 n...
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| Veröffentlicht in: | The Journal of pediatrics 2020-02, Vol.217, p.86-91.e1 |
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| creator | Fry, Jessica T. Matoba, Nana Datta, Ankur DiGeronimo, Robert Coghill, Carl H. Natarajan, Girija Brozanski, Beverly Leuthner, Steven R. Niehaus, Jason Z. Schlegel, Amy Brown Shah, Anita Zaniletti, Isabella Bartman, Thomas Murthy, Karna Sullivan, Kevin M. Asselin, Jeanette Durand, David Dykes, Francine Evans, Jacquelyn Murthy, Karna Padula, Michael Pallotto, Eugenia Grover, Theresa Piazza, Anthony Reber, Kristina Short, Billie |
| description | To assess the impact of intercenter variation and patient factors on end-of-life care practices for infants who die in regional neonatal intensive care units (NICUs).
We conducted a retrospective cohort analysis using the Children's Hospital Neonatal Database during 2010-2016. A total of 6299 nonsurviving infants cared for in 32 participating regional NICUs were included to examine intercenter variation and the effects of gestational age, race, and cause of death on 3 end-of-life care practices: do not attempt resuscitation orders (DNR), cardiopulmonary resuscitation within 6 hours of death (CPR), and withdrawal of life-sustaining therapies (WLST). Factors associated with these practices were used to develop a multivariable equation.
Dying infants in the cohort underwent DNR (55%), CPR (21%), and WLST (73%). Gestational age, cause of death, and race were significantly and differently associated with each practice: younger gestational age ( |
| doi_str_mv | 10.1016/j.jpeds.2019.10.039 |
| format | Article |
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We conducted a retrospective cohort analysis using the Children's Hospital Neonatal Database during 2010-2016. A total of 6299 nonsurviving infants cared for in 32 participating regional NICUs were included to examine intercenter variation and the effects of gestational age, race, and cause of death on 3 end-of-life care practices: do not attempt resuscitation orders (DNR), cardiopulmonary resuscitation within 6 hours of death (CPR), and withdrawal of life-sustaining therapies (WLST). Factors associated with these practices were used to develop a multivariable equation.
Dying infants in the cohort underwent DNR (55%), CPR (21%), and WLST (73%). Gestational age, cause of death, and race were significantly and differently associated with each practice: younger gestational age (<28 weeks) was associated with CPR (OR 1.7, 95% CI 1.5-2.1) but not with DNR or WLST, and central nervous system injury was associated with DNR (1.6, 1.3-1.9) and WLST (4.8, 3.7-6.2). Black race was associated with decreased odds of WLST (0.7, 0.6-0.8). Between centers, practices varied widely at different gestational ages, race, and causes of death.
From the available data on end-of-life care practices for regional NICU patients, variability appears to be either individualized or without consistency.</description><identifier>ISSN: 0022-3476</identifier><identifier>EISSN: 1097-6833</identifier><identifier>DOI: 10.1016/j.jpeds.2019.10.039</identifier><identifier>PMID: 31831163</identifier><language>eng</language><publisher>NEW YORK: Elsevier Inc</publisher><subject>Children's Hospitals Neonatal Consortium ; Children's Hospitals Neonatal Database ; end-of-life care ; Life Sciences & Biomedicine ; neonatal death ; neonatal intensive care ; Pediatrics ; Science & Technology</subject><ispartof>The Journal of pediatrics, 2020-02, Vol.217, p.86-91.e1</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>16</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000508641400016</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c359t-2bf6d184cd8ba22b16d8212b1f7f97bd99a9dfd83e42177ccff30045026ebda63</citedby><cites>FETCH-LOGICAL-c359t-2bf6d184cd8ba22b16d8212b1f7f97bd99a9dfd83e42177ccff30045026ebda63</cites><orcidid>0000-0003-3363-9663 ; 0000-0002-4801-137X ; 0000-0002-5096-4030</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpeds.2019.10.039$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3552,27931,27932,28255,46002</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31831163$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fry, Jessica T.</creatorcontrib><creatorcontrib>Matoba, Nana</creatorcontrib><creatorcontrib>Datta, Ankur</creatorcontrib><creatorcontrib>DiGeronimo, Robert</creatorcontrib><creatorcontrib>Coghill, Carl H.</creatorcontrib><creatorcontrib>Natarajan, Girija</creatorcontrib><creatorcontrib>Brozanski, Beverly</creatorcontrib><creatorcontrib>Leuthner, Steven R.</creatorcontrib><creatorcontrib>Niehaus, Jason Z.</creatorcontrib><creatorcontrib>Schlegel, Amy Brown</creatorcontrib><creatorcontrib>Shah, Anita</creatorcontrib><creatorcontrib>Zaniletti, Isabella</creatorcontrib><creatorcontrib>Bartman, Thomas</creatorcontrib><creatorcontrib>Murthy, Karna</creatorcontrib><creatorcontrib>Sullivan, Kevin M.</creatorcontrib><creatorcontrib>Asselin, Jeanette</creatorcontrib><creatorcontrib>Durand, David</creatorcontrib><creatorcontrib>Dykes, Francine</creatorcontrib><creatorcontrib>Evans, Jacquelyn</creatorcontrib><creatorcontrib>Murthy, Karna</creatorcontrib><creatorcontrib>Padula, Michael</creatorcontrib><creatorcontrib>Pallotto, Eugenia</creatorcontrib><creatorcontrib>Grover, Theresa</creatorcontrib><creatorcontrib>Piazza, Anthony</creatorcontrib><creatorcontrib>Reber, Kristina</creatorcontrib><creatorcontrib>Short, Billie</creatorcontrib><creatorcontrib>Children's Hospital Neonatal Consortium (CHNC)</creatorcontrib><creatorcontrib>CHNC</creatorcontrib><title>Center, Gestational Age, and Race Impact End-of-Life Care Practices at Regional Neonatal Intensive Care Units</title><title>The Journal of pediatrics</title><addtitle>J PEDIATR-US</addtitle><addtitle>J Pediatr</addtitle><description>To assess the impact of intercenter variation and patient factors on end-of-life care practices for infants who die in regional neonatal intensive care units (NICUs).
We conducted a retrospective cohort analysis using the Children's Hospital Neonatal Database during 2010-2016. A total of 6299 nonsurviving infants cared for in 32 participating regional NICUs were included to examine intercenter variation and the effects of gestational age, race, and cause of death on 3 end-of-life care practices: do not attempt resuscitation orders (DNR), cardiopulmonary resuscitation within 6 hours of death (CPR), and withdrawal of life-sustaining therapies (WLST). Factors associated with these practices were used to develop a multivariable equation.
Dying infants in the cohort underwent DNR (55%), CPR (21%), and WLST (73%). Gestational age, cause of death, and race were significantly and differently associated with each practice: younger gestational age (<28 weeks) was associated with CPR (OR 1.7, 95% CI 1.5-2.1) but not with DNR or WLST, and central nervous system injury was associated with DNR (1.6, 1.3-1.9) and WLST (4.8, 3.7-6.2). Black race was associated with decreased odds of WLST (0.7, 0.6-0.8). Between centers, practices varied widely at different gestational ages, race, and causes of death.
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We conducted a retrospective cohort analysis using the Children's Hospital Neonatal Database during 2010-2016. A total of 6299 nonsurviving infants cared for in 32 participating regional NICUs were included to examine intercenter variation and the effects of gestational age, race, and cause of death on 3 end-of-life care practices: do not attempt resuscitation orders (DNR), cardiopulmonary resuscitation within 6 hours of death (CPR), and withdrawal of life-sustaining therapies (WLST). Factors associated with these practices were used to develop a multivariable equation.
Dying infants in the cohort underwent DNR (55%), CPR (21%), and WLST (73%). Gestational age, cause of death, and race were significantly and differently associated with each practice: younger gestational age (<28 weeks) was associated with CPR (OR 1.7, 95% CI 1.5-2.1) but not with DNR or WLST, and central nervous system injury was associated with DNR (1.6, 1.3-1.9) and WLST (4.8, 3.7-6.2). Black race was associated with decreased odds of WLST (0.7, 0.6-0.8). Between centers, practices varied widely at different gestational ages, race, and causes of death.
From the available data on end-of-life care practices for regional NICU patients, variability appears to be either individualized or without consistency.</abstract><cop>NEW YORK</cop><pub>Elsevier Inc</pub><pmid>31831163</pmid><doi>10.1016/j.jpeds.2019.10.039</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-3363-9663</orcidid><orcidid>https://orcid.org/0000-0002-4801-137X</orcidid><orcidid>https://orcid.org/0000-0002-5096-4030</orcidid></addata></record> |
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| subjects | Children's Hospitals Neonatal Consortium Children's Hospitals Neonatal Database end-of-life care Life Sciences & Biomedicine neonatal death neonatal intensive care Pediatrics Science & Technology |
| title | Center, Gestational Age, and Race Impact End-of-Life Care Practices at Regional Neonatal Intensive Care Units |
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