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The following is a summary of “Complex end-of-life decision-making during neonatal retrieval: A retrospective cohort study,” published in the October 2024 issue of Pediatrics by Cantelmi et al.
Complex end-of-life decision-making in neonatal care can impact patient outcomes, particularly in cases of prematurity and hypoxic-ischemic encephalopathy (HIE).
Researchers conducted a retrospective study comparing infants who were palliated before transfer to those who were palliated after transfer within 7 days of birth.
They analyzed infants referred to the neonatal retrieval service between December 1, 2015, and March 31, 2022, who died during retrieval or within 7 days of referral.
The results showed that 25 (42%) infants were not transported and were palliated, while 35 (58%) infants were transported and further palliated at the hospital. Prematurity (42%) and HIE (42%) were primary diagnoses. Infants palliated at the referring hospital required resuscitation, including chest compressions more often (52% vs. 23%, P=0.02), management for hypotension (72% vs. 20%, P<0.001), and management for pneumothorax (28% vs. 0%, P=0.001) and were less likely to need management for seizures (8% vs. 43%, P=0.003).
They concluded that palliation at the referring hospital should be considered when escalation of care was unlikely to improve outcomes, as infants requiring transport often needed significant management during stabilization.