Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
J Chin Med Assoc. 2020 Aug;83(8):774-778. doi: 10.1097/JCMA.0000000000000346.
The advancements in neonatal critical care have not only improved the outcomes of extreme prematurity but also prolonged the process of death in terminally ill neonates. This study analyzed the characteristics of neonates who died at a single tertiary center in Taiwan. The utilization of neonatal hospice care before and after the legalization of life-sustaining treatment (LST) withdrawal in Taiwan in 2013 was also compared.
This study enrolled the neonatal mortality cases in the Taipei Veterans General Hospital during January 2008 to December 2017 through chart review. Data on birth history, primary diagnosis, complications, and death circumstances were recorded and analyzed.
In total, 105 neonatal deaths were analyzed. The circumstances of death were as follows: 22 (21%) cases of full LST and cardiopulmonary resuscitation (CPR) performed until death; 63 (60%) cases of LST initiated but no more CPR after do-not-resuscitate (DNR) consents signed; 8 (7.6%) cases of LST withdrawn; 4 (3.8%) cases of DNR signed without LST initiation; 3 (2.9%) cases of CPR not performed, although no DNR signed; and 5 (4.8%) cases of discharge against medical advice under critical condition. The incidence of written DNR consents (57.9% in 2008-2009 vs 93.8% in 2016-2017; p = 0.02) showed an increasing trend. Regarding the incidence of comorbidities, renal failure rate was higher in the DNR group than in the non-DNR group (p = 0.002).
There was an increasing trend for written DNR consent and the utilization of neonatal hospice care. Renal failure, as a comorbidity, was significantly associated with the written DNR consent in the neonates. Further studies to evaluate the factors associated with neonatal hospice care utilization are suggested.
新生儿重症监护的进步不仅改善了极早产儿的结局，而且延长了终末期患病新生儿的死亡过程。本研究分析了在台湾一家三级中心死亡的新生儿的特征。还比较了 2013 年台湾合法化维持生命治疗（LST）撤机前后新生儿临终关怀的利用情况。
本研究通过病历回顾，纳入了 2008 年 1 月至 2017 年 12 月期间台北荣民总医院的新生儿死亡病例。记录并分析了出生史、主要诊断、并发症和死亡情况的数据。
共分析了 105 例新生儿死亡病例。死亡情况如下：22 例（21%）进行了全面 LST 和心肺复苏（CPR）直至死亡；63 例（60%）签署不复苏（DNR）同意书后开始 LST 但不再进行 CPR；8 例（7.6%）停止 LST；4 例（3.8%）签署 DNR 但未开始 LST；3 例（2.9%）未进行 CPR，但未签署 DNR；5 例（4.8%）在危急情况下未经同意出院。书面 DNR 同意书的发生率（2008-2009 年为 57.9%，2016-2017 年为 93.8%；p=0.02）呈上升趋势。关于合并症的发生率，DNR 组的肾衰竭发生率高于非 DNR 组（p=0.002）。
书面 DNR 同意书和新生儿临终关怀的使用呈上升趋势。肾衰竭作为一种合并症，与新生儿书面 DNR 同意书显著相关。建议进一步研究评估与新生儿临终关怀利用相关的因素。
