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Retrospective cohort study of all deaths among infants born between 22 and 27 completed weeks of gestation in Switzerland over a 3-year period

2017; BMJ; Volume: 7; Issue: 6 Linguagem: Inglês

10.1136/bmjopen-2016-015179

2044-6055

Thomas M. Berger, Martina Steurer, Hans Ulrich Bucher, Jean‐Claude Fauchère, Mark Adams, Riccardo Pfister, Ruth Baumann‐Hölzle, Dirk Bassler,

Neuroscience of respiration and sleep

The aim of this research is to assess causes and circumstances of deaths in extremely low gestational age neonates (ELGANs) born in Switzerland over a 3-year period.Population-based, retrospective cohort study.All nine level III perinatal centres (neonatal intensive care units (NICUs) and affiliated obstetrical services) in Switzerland.ELGANs with a gestational age (GA) <28 weeks who died between 1 July 2012 and 30 June 2015.A total of 594 deaths were recorded with 280 (47%) stillbirths and 314 (53%) deaths after live birth. Of the latter, 185 (59%) occurred in the delivery room and 129 (41%) following admission to an NICU. Most liveborn infants dying in the delivery room had a GA ≤24 weeks and died following primary non-intervention. In contrast, NICU deaths occurred following unrestricted life support regardless of GA. End-of-life decision-making and redirection of care were based on medical futility and anticipated poor quality of life in 69% and 28% of patients, respectively. Most infants were extubated before death (87%).In Switzerland, most deaths among infants born at less than 24 weeks of gestation occurred in the delivery room. In contrast, most deaths of ELGANs with a GA ≥24 weeks were observed following unrestricted provisional intensive care, end-of-life decision-making and redirection of care in the NICU regardless of the degree of immaturity.