Trends in length of stay for neonatal intensive care unit patients who die before hospital discharge

Article

GUTTMANN, Katherine | PUOPLO, Nicholas | RICHTER, Felix | WEINTRAUB, Andrea

OBJECTIVES: To establish days between birth and death for neonates over a 14-year period, to determine if days between birth and death has changed over time across gestational age (GA) cohorts, and identify diagnoses which may put infants at high risk of prolonged hospitalization leading to death. STUDY DESIGN: This was a single-site, retrospective chart review of inborn infants who died prior to hospital discharge. RESULTS: 239 patients born between 1/1/2006 and 12/31/2020 met inclusion criteria. Days until death ranged from 0-300 with a median of 6 days (IQR= 23). Median days until death increased over time, with a statistically significant increase between epoch 1 and epoch 2 (p = 0.016) but not between epoch 2 and epoch 3 (p = 0.618). Extremely premature infants died earlier than more mature infants (p < 0.001). In addition, infants who died as a result of complex congenital heart disease or a gastrointestinal (GI) catastrophe died later (p < 0.001 and p < 0.001, respectively) than newborns without cardiac or GI issues. CONCLUSIONS: Our findings demonstrate an increase in time to death for newborns who did not survive to hospital discharge over a 14-year period. This trend suggests that the dynamics informing Meadows' assertion that 'doomed infants die early' may be shifting, with some seriously ill infants who die before hospital discharge surviving longer than previously described. More research is needed to understand how best to care for babies who will not survive to discharge and to explore when supports such as palliative care consultation may be beneficial.

http://dx.doi.org/10.1055/a-1712-5313

Voir la revue «American journal of perinatology»

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