Roy R, Aladangady N, Costeloe K, Larcher V
Homerton University Hospital, London E9 6SR, UK.
Arch Dis Child Fetal Neonatal Ed. 2004 Nov;89(6):F527-30. doi: 10.1136/adc.2003.032912.
To study the frequency and reason for withdrawal/withholding of life sustaining treatment (LST) and do not resuscitate (DNR) orders in infants who died in a tertiary neonatal unit.
Infants who died at Homerton University Hospital between January 1998 and September 2001 were studied by retrospective analysis of patient records.
The case notes of 71 (84%) of 85 infants who died were studied. Mode of death was withdrawal of LST in 28 (40%), DNR in 11 (15%), withholding of LST in two (3%), and natural in 30 (42%) infants. Withdrawal of LST was discussed with the parents of 39 seriously ill infants; 28 (72%) parents agreed. There was no difference in birth weight and gestational age of babies whose parents agreed or refused withdrawal of LST. White and Afro-Caribbean parents and those from the Indian subcontinent (20 of 23) were more likely to agree to withdrawal of LST than Black African or Jewish (eight of 16, p = 0.015) parents. The median age at withdrawal of LST was 4 days (range 1-57). The median duration between discussion and the parents agreeing to withdrawal of LST was 165 minutes (range 30-2160), and median duration between withdrawal of LST and death was 22 minutes (range 5-210). The most common reason for withdrawal of LST was complications of extreme prematurity (68%).
The most common mode of death was withdrawal of LST, and the most common reason was complications of extreme prematurity. The ethnic and cultural background of the parents influenced agreement to withdrawal of LST.
研究在一家三级新生儿重症监护病房死亡的婴儿中，撤除/停止维持生命治疗（LST）及下达不进行心肺复苏（DNR）医嘱的频率和原因。
通过对患者病历进行回顾性分析，研究1998年1月至2001年9月期间在霍默顿大学医院死亡的婴儿。
对85例死亡婴儿中的71例（84%）的病历进行了研究。死亡方式为28例（40%）婴儿的LST被撤除，11例（15%）下达了DNR医嘱，2例（3%）婴儿的LST被停止，30例（42%）婴儿自然死亡。与39例重症婴儿的父母讨论了撤除LST的问题；28例（72%）父母同意。父母同意或拒绝撤除LST的婴儿在出生体重和胎龄方面没有差异。白人、非裔加勒比人和来自印度次大陆的父母（23例中的20例）比非洲黑人或犹太父母（16例中的8例，p = 0.015）更有可能同意撤除LST。撤除LST的中位年龄为4天（范围1 - 57天）。从讨论到父母同意撤除LST的中位持续时间为165分钟（范围30 - 2160分钟），从撤除LST到死亡的中位持续时间为22分钟（范围5 - 210分钟）。撤除LST最常见的原因是极早早产的并发症（68%）。
最常见的死亡方式是撤除LST，最常见的原因是极早早产的并发症。父母的种族和文化背景影响了对撤除LST的同意与否。
