Published online August 1, 2006
PEDIATRICS Vol. 118 No. 2 August 2006, pp. 563-569 (doi:10.1542/peds.2005-1615)
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ARTICLE

Restriction of Ongoing Intensive Care in Neonates: A Prospective Study

Roland Hentschel, MDa, Katharina Lindner, MDb, Markus Krueger, MDa and Stella Reiter-Theil, PhDb

a Department of Pediatrics and Adolescent Medicine, Division of Neonatology, University of Freiburg, Freiburg, Germany
b Institute for Applied Ethics and Medical Ethics, University of Basel, Basel, Switzerland

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.

Key Words: medical ethics • newborn • palliative care • euthanasia • intensive care

Abbreviations: RIC—restriction of ongoing intensive care • CPR—cardiopulmonary resuscitation

Accepted Mar 17, 2006.


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