新生儿重症监护病房的死亡情况：二十多年来临终关怀模式的变化
Death in the neonatal intensive care unit: changing patterns of end of life care over two decades.
作者信息
Wilkinson D J, Fitzsimons J J, Dargaville P A, Campbell N T, Loughnan P M, McDougall P N, Mills J F
机构信息
Department of Neonatology, Royal Children's Hospital, Parkville, Melbourne, Victoria 3052, Australia.
出版信息
Arch Dis Child Fetal Neonatal Ed. 2006 Jul;91(4):F268-71. doi: 10.1136/adc.2005.074971.
BACKGROUND
Death remains a common event in the neonatal intensive care unit, and often involves limitation or withdrawal of life sustaining treatment.
OBJECTIVE
To document changes in the causes of death and its management over the last two decades.
METHODS
An audit of infants dying in the neonatal intensive care unit was performed during two epochs (1985-1987 and 1999-2001). The principal diagnoses of infants who died were recorded, as well as their apparent prognoses, and any decisions to limit or withdraw medical treatment.
RESULTS
In epoch 1, 132 infants died out of 1362 admissions (9.7%), and in epoch 2 there were 111 deaths out of 1776 admissions (6.2%; p<0.001). Approximately three quarters of infants died after withdrawal of life sustaining treatment in both epochs. There was a significant reduction in the proportion of deaths from chromosomal abnormalities, and from neural tube defects in epoch 2.
CONCLUSIONS
There have been substantial changes in the illnesses leading to death in the neonatal intensive care unit. These may reflect the combined effects of prenatal diagnosis and changing community and medical attitudes.
背景
在新生儿重症监护病房，死亡仍是常见事件，且常涉及维持生命治疗的限制或撤除。
目的
记录过去二十年中死亡原因及其管理的变化。
方法
在两个时期（1985 - 1987年和1999 - 2001年）对在新生儿重症监护病房死亡的婴儿进行审计。记录死亡婴儿的主要诊断、其明显的预后以及任何限制或撤除医疗治疗的决定。
结果
在第1期，1362例入院婴儿中有132例死亡（9.7%），在第2期，1776例入院婴儿中有111例死亡（6.2%；p<0.001）。在两个时期中，约四分之三的婴儿在撤除维持生命治疗后死亡。第2期染色体异常和神经管缺陷导致的死亡比例显著降低。
结论
新生儿重症监护病房导致死亡的疾病发生了重大变化。这些变化可能反映了产前诊断以及不断变化的社会和医学观念的综合影响。
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