Verhagen A A E, Dorscheidt J H H M, Engels B, Hubben J H, Sauer P J
Department of Paediatrics, Beatrix Children's Hospital/ University Medical Centre Groningen, 9700 RB Groningen, the Netherlands.
Arch Dis Child Fetal Neonatal Ed. 2009 Nov;94(6):F434-8. doi: 10.1136/adc.2008.149260. Epub 2009 Jul 1.
Clinicians frequently administer analgesics and sedatives at the time of withholding or withdrawal of life-sustaining treatment in newborns. This practice might be regarded as intentionally hastening of death.
To describe type, doses and reasons for administering medications as part of end-of-life decisions in the Dutch neonatal intensive care units.
We reviewed the medical files of 340 newborn deaths with a preceding end-of-life decision over a 12-month period to describe the use of analgesics, sedatives and/or neuromuscular blockers. The neonatologists of 147 of the 150 newborns with a preceding end-of-life decision based on the infant's poor prognosis were interviewed to obtain additional details about the use of medication.
Analgesics and sedatives were administered to 224 of 340 newborns before the end-of-life decision and to 292 newborns after the decision. The medication was increased in 94 of 289 newborns whose death was imminent and in 110 of 150 newborns with a poor prognosis. Reasons for the increase were treatment of pain and suffering, and in 4% of cases hastening of death. Reasons were undocumented in 55% of deaths. Neuromuscular blockers were administered in 16% of patients because they already received these agents or to stop or prevent gasping.
Analgesics and sedatives are generally increased after the end-of-life decision to treat pain and suffering and rarely to hasten death. Neuromuscular blockers were administered in 16% of deaths. Medical files provide insufficient documentation of considerations leading to the increase of medication, which hinders (external) review.
临床医生在对新生儿停止或撤除维持生命治疗时经常给予镇痛药和镇静剂。这种做法可能被视为故意加速死亡。
描述荷兰新生儿重症监护病房在临终决策中使用药物的类型、剂量及原因。
我们回顾了12个月期间340例有临终决策的新生儿死亡病例的医疗档案，以描述镇痛药、镇静剂和/或神经肌肉阻滞剂的使用情况。对150例基于婴儿预后不良做出临终决策的新生儿中的147例新生儿科医生进行了访谈，以获取关于用药的更多细节。
在临终决策前，340例新生儿中有224例接受了镇痛药和镇静剂治疗，决策后有292例新生儿接受了此类治疗。在289例濒死新生儿中有94例以及150例预后不良的新生儿中有110例增加了用药剂量。增加用药的原因是治疗疼痛和痛苦，4%的病例是为了加速死亡。55%的死亡病例未记录原因。16%的患者使用了神经肌肉阻滞剂，原因是他们已经在使用这些药物，或者是为了停止或防止喘息。
临终决策后通常会增加镇痛药和镇静剂的使用以治疗疼痛和痛苦，很少是为了加速死亡。16%的死亡病例使用了神经肌肉阻滞剂。医疗档案对导致用药增加的考量记录不足，这妨碍了（外部）审查。
