BMJ paediatrics open · 2025
Short-term outcomes of treatment limitation discussions in neonatal care units of tertiary care hospital in Karachi, Pakistan: a cross-sectional study.
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Iqbal Rozina, Siddiqui Ariba, Khan Wajiha, Pasha Aneela, Aziz Danish Abdul, Rahman Arshalooz
Аннотация
OBJECTIVE: To determine the short-term outcomes of treatment limitation discussions (TLDs) in neonates with life-limiting conditions and life-threatening conditions.
DESIGN: Descriptive cross-sectional study.
SETTINGS: The study was conducted at the neonatal care units of a single tertiary care hospital in Karachi, Pakistan.
PATIENTS: Neonates for whom clinicians or parents considered TLDs were included in the study. The study duration was from May 2022 to May 2023.
INTERVENTIONS: None.
MAIN OUTCOME MEASURES: Primary outcome was documented in the form of frequency of full code, withdrawal of life-sustaining support, and do not resuscitate (DNR) orders in neonates. The secondary outcome was categorised as discharge, death, transfer from the neonatal intensive care unit (NICU) to a step-down unit or leave against medical advice (LAMA).
RESULTS: A total of 115 patients were included. Full code was documented in 14 patients (12.2%), withdrawal of life-sustaining support in 54 cases (47.0%) and DNR in 47 patients (40.9%). Of the 115 cases, 11 (9.6%) were discharged, 90 (78.3%) died, 7 (6.1%) were shifted out of the NICU and 7 (6.1%) LAMA. We found that 14 out of 115 parents (12.2%) chose the full code option despite clinicians advising withdrawal or DNR. Of those, 13 (92.8%) did not survive, and 1 (7.1%) was shifted out of the NICU.
CONCLUSIONS: The most frequent outcome after TLD was withdrawal of life-sustaining support. The majority of babies did not survive following TLD, irrespective of the code decided. Early transition out of the NICU was considered for babies with DNR orders.
DESIGN: Descriptive cross-sectional study.
SETTINGS: The study was conducted at the neonatal care units of a single tertiary care hospital in Karachi, Pakistan.
PATIENTS: Neonates for whom clinicians or parents considered TLDs were included in the study. The study duration was from May 2022 to May 2023.
INTERVENTIONS: None.
MAIN OUTCOME MEASURES: Primary outcome was documented in the form of frequency of full code, withdrawal of life-sustaining support, and do not resuscitate (DNR) orders in neonates. The secondary outcome was categorised as discharge, death, transfer from the neonatal intensive care unit (NICU) to a step-down unit or leave against medical advice (LAMA).
RESULTS: A total of 115 patients were included. Full code was documented in 14 patients (12.2%), withdrawal of life-sustaining support in 54 cases (47.0%) and DNR in 47 patients (40.9%). Of the 115 cases, 11 (9.6%) were discharged, 90 (78.3%) died, 7 (6.1%) were shifted out of the NICU and 7 (6.1%) LAMA. We found that 14 out of 115 parents (12.2%) chose the full code option despite clinicians advising withdrawal or DNR. Of those, 13 (92.8%) did not survive, and 1 (7.1%) was shifted out of the NICU.
CONCLUSIONS: The most frequent outcome after TLD was withdrawal of life-sustaining support. The majority of babies did not survive following TLD, irrespective of the code decided. Early transition out of the NICU was considered for babies with DNR orders.