Congratulations to Béatrice for her new article about the long term outcomes of babies who survive after life-and-death discussions and decisions.
Objective: To investigate long-term outcomes of infants who survive despite life-and-death discussions with families and a decision to withdraw or withhold life-sustaining interventions (WWLST) in one neonatal intensive care unit (NICU).
Study design: Medical records for NICU admissions from 2012-2017 were reviewed for presence of WWLST discussions or decisions, as well as the 2-year outcome of all children who survived. WWLST discussions were prospectively recorded in a specific book; follow-up up to age two was determined by retrospective chart review.
Results: WWLST discussions occurred for 266 of 5251 infants (5%): 151 (57%) were born at term and 115 (43%) were born preterm. Among these discussions, 164 led to an WWLST decision (62%) and 130 were followed by the infant’s death (79%). Of the 34 children (21%) surviving to discharge after WWLST decisions, 10 (29%) died before 2 years of age and 11 (32%) required frequent medical follow-up. Major functional limitations were common among survivors, but eight were classified as functionally normal or with mild to moderate functional limitations.
Conclusions: When a WWLST decision was made in our cohort, 21% of the infants survived to discharge. By 2 years of age, the majority of these infants had died or had major functional limitations. This highlights the uncertainty of WWLST decisions during neonatal intensive care, and the importance of ensuring that parents are informed of all possibilities. Additional studies including longer-term follow-up and ascertaining the family’s views will be important.