Short-term outcomes of treatment limitation discussions in neonatal care units of tertiary care hospital in Karachi, Pakistan: a cross-sectional study.

OBJECTIVE

To determine the short-term outcomes of treatment limitation discussions (TLDs) in neonates with life-limiting conditions and life-threatening conditions.

DESIGN

Descriptive cross-sectional study.

SETTINGS

The study was conducted at the neonatal care units of a single tertiary care hospital in Karachi, Pakistan.

PATIENTS

Neonates for whom clinicians or parents considered TLDs were included in the study. The study duration was from May 2022 to May 2023.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Primary outcome was documented in the form of frequency of full code, withdrawal of life-sustaining support, and do not resuscitate (DNR) orders in neonates. The secondary outcome was categorised as discharge, death, transfer from the neonatal intensive care unit (NICU) to a step-down unit or leave against medical advice (LAMA).

RESULTS

A total of 115 patients were included. Full code was documented in 14 patients (12.2%), withdrawal of life-sustaining support in 54 cases (47.0%) and DNR in 47 patients (40.9%). Of the 115 cases, 11 (9.6%) were discharged, 90 (78.3%) died, 7 (6.1%) were shifted out of the NICU and 7 (6.1%) LAMA. We found that 14 out of 115 parents (12.2%) chose the full code option despite clinicians advising withdrawal or DNR. Of those, 13 (92.8%) did not survive, and 1 (7.1%) was shifted out of the NICU.

CONCLUSIONS

The most frequent outcome after TLD was withdrawal of life-sustaining support. The majority of babies did not survive following TLD, irrespective of the code decided. Early transition out of the NICU was considered for babies with DNR orders.