Restriction of Ongoing Intensive Care in Neonates: A Prospective Study

Abstract

OBJECTIVE. The purpose of this work was to record the current practice of restricting ongoing intensive care in severely ill newborns. METHODS. This was a prospective observational study over a 30-month period of consecutive newborns for whom restriction of ongoing intensive care was taken into consideration, discussed, or decided on. A standardized form recorded patients' medical condition, the type of restriction decided on, parents' wishes, and their information level. The research was conducted in a neonatal unit of a level III university children's hospital, with no interventions. RESULTS. Forty patients were enrolled, 25 were preterm, 21 had either a genetic defect or an inborn malformation. Restriction of ongoing intensive care was decided on for 32 patients with a great variety of specified recommendations. Thirty-six patients died during the observation period. In general, parents were well informed; however, their wishes concerning restriction of ongoing intensive care were unknown in ∼25% of cases. CONCLUSIONS. The decision-making process for restriction of ongoing intensive care is well established, but the role of parents needs to be defined.