Verhagen A A Eduard, van der Hoeven Mark A H, van Meerveld R Corine, Sauer Pieter J J
Department of Pediatrics, University Medical Center Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands.
Pediatrics. 2007 Jul;120(1):e20-8. doi: 10.1542/peds.2006-2555.
Decisions regarding end-of-life care in critically ill newborns in The Netherlands have received considerable criticism from the media and from the public. This might be because of a lack of proper information and knowledge. Our purpose was to provide detailed information about how and when the implementation of end-of-life decisions, which are based on quality-of-life considerations, takes place.
We reviewed the charts of all infants who died within the first 2 months of life at 2 university hospitals in The Netherlands from January to July 2005 and extracted all relevant information about the end-of-life decisions. We interviewed the responsible neonatologists about the end-of-life decisions and the underlying quality-of-life considerations and about the process of implementation.
Of a total of 30 deaths, 28 were attributable to withholding or withdrawing life-sustaining treatment. In 18 of 28 cases, the infant had no chance to survive; in 10 cases, the final decision was based on the poor prognosis of the infant. In 6 patients, 2 successive different end-of-life decisions were made. The arguments that most frequently were used to conclude that quality of life was deemed poor were predicted suffering and predicted inability of verbal and nonverbal communication. Implementation consisted of discontinuation of ventilatory support and alleviation of pain and symptoms. Neuromuscular blockers were added shortly before death in 5 cases to prevent gasping, mostly on parental request.
The majority of deaths were attributable to withholding or withdrawing treatment. In most cases, the newborn had no chance to survive and prolonging of treatment could not be justified. In the remaining cases, withholding or withdrawing treatment was based on quality-of-life considerations, mostly the predicted suffering and predicted inability of verbal and nonverbal communication. Potentially life-shortening medication played a minor role as a cause of death.
荷兰针对危重新生儿临终关怀的决策受到了媒体和公众的诸多批评。这可能是由于缺乏适当的信息和知识。我们的目的是提供详细信息，说明基于生活质量考量的临终决策是如何以及何时实施的。
我们回顾了2005年1月至7月在荷兰两家大学医院出生后两个月内死亡的所有婴儿的病历，并提取了所有与临终决策相关的信息。我们就临终决策、潜在的生活质量考量以及实施过程采访了负责的新生儿科医生。
在总共30例死亡病例中，28例归因于停止或撤销维持生命的治疗。在28例中的18例中，婴儿没有存活机会；在10例中，最终决策基于婴儿的预后不良。在6例患者中，做出了连续两次不同的临终决策。最常被用来判定生活质量差的论据是预测的痛苦以及预测的无法进行言语和非言语交流。实施措施包括停止通气支持以及减轻疼痛和症状。5例在死亡前不久添加了神经肌肉阻滞剂以防止喘息，大多是应家长要求。
大多数死亡归因于停止或撤销治疗。在大多数情况下，新生儿没有存活机会，延长治疗不合理。在其余情况下，停止或撤销治疗基于生活质量考量，主要是预测的痛苦以及预测的无法进行言语和非言语交流。可能缩短生命的药物作为死因起的作用较小。
