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Table 3 Impact of the LWAT file on end-of-life management

From: Formal procedure to facilitate the decision to withhold or withdraw life-sustaining interventions in a neonatal intensive care unit: a seven-year retrospective study

 

Cohort 1 with meeting (n = 25)

Cohort 2 Meeting + file (n = 52)

p value

Age at death, mean (+/− SD), median (IQR) (days)

28.3 (36.4)

14 (36)

21.7 (25.6)

11 (17.5)

0.556

Death < 1 week, n (%)

8 (32)

17 (32.7)

0.952

Birth context, n (%)

 Severe hypoxic-ischemic encephalopathy

4 (16)

9 (17.3)

0.445

 Congenital anomaly

5 (20)

5 (9.6)

 Premature

7 (28)

11 (21.2)

 Weight less than 1000 g

9 (36)

27 (51.9)

Verhagen classification, n (%)

 Class 1

0

1 (1.9)

0.654

 Class 2

1 (4)

3 (5.8)

 Class 3

7 (28)

9 (17.3)

 Class 4

17 (68)

39 (75)

 Parental opinion before meeting

4 (16.7)

25 (48.1)

0.009

Pathology prompting the meeting, n (%)

 Severe hypoxic-ischemic encephalopathy

5 (20)

8 (15.4)

0.742

 Other neurological disease

12 (48)

30 (57.7)

 Sepsis

1 (4)

3 (5.8)

 Congenital anomaly

3 (12)

6 (11.5)

 Acute respiratory disease

1 (4)

1 (1.9)

 Other

3 (12)

4 (7.5)

Cause of death, n (%)

 Severe hypoxic-ischemic encephalopathy

4 (16)

9 (17.3)

0.774

 Other neurological injury

13 (52)

27 (51.9)

 Sepsis

1 (4)

2 (3.8)

 Hemodynamic failure

2 (8)

7 (13.5)

 Congenital anomaly

4 (16)

6 (11.5)

 Respiratory failure

1 (4)

1 (1.9)

Lifetime according to pathology, median (IQR)

 Severe hypoxic-ischemic encephalopathy

13 (14.5)

11 (5.5)

0.337

 Congenital anomaly

20 (112.5)

31 (41)

 Premature

15 (37)

11 (21)

 Weight < 1000 g

11 (54.5)

9 (17)

 Understanding of end-of -life conditions, n (%)

21 (84)

51 (98.1)

0.019

Decision at the end of the meeting, n (%)

 Continue treatment

1

0

0.318

 Withhold treatment

7

14 (26.9)

 Withdraw treatment

16

38 (73.1)

 Sedation, n (%)

24 (96)

49 (94.2)

0.743

 Hypnotics

5 (20)

25 (48.1)

0.018

 Morphine

23 (92)

48 (92.3)

0.962

Ventilation support at time of death, n (%)

6 (24)

12 (23.1)

0.929

 Mechanical ventilation

5 (20)

11 (21.2)

0.864

 CPAP

1 (4)

1 (1.9)

 High flow nasal canulea

0

0

  1. Verhagen classification: class 1: children who died despite cardiopulmonary resuscitation (CPR) (no withholding nor withdrawing of LSIs), class 2: children who died while the ventilator, without CPR (no withdrawing of LSIs, but CPR withheld), class 3: children who died after LSIs were withdrawn or class 4: LSIs were withheld