Deaths in the Neonatal Intensive Care Unit between 2002 and 2014

Park, Ga Young; Kim, Sung Shin

Abstract

PURPOSE
To report the causes and patterns of death among infants admitted to our neonatal intensive care unit (NICU) over a 13-year period. In addition, we analyzed trends regarding the type of end-of-life care provided.
METHODS
All of the neonates who died at the Soonchunhyang University Bucheon Hospital between January 1, 2002, and December 31, 2014, were identified. The causes and circumstances of death were extracted from individual medical records. Trends in mortality were compared between two time periods: 2002 to 2007 and 2008 to 2014.
RESULTS
Of the 5,223 admissions to our NICU, 97 neonates died. The overall mortality rate was 1.9%. The most common cause of death was sepsis (15%). At a lower gestational age, infants died of extreme prematurity and complications of prematurity. Among term infants, the principal cause of death shifted to hypoxic ischemic encephalopathy and asphyxia. A total of 63 infants (64.9%) received maximal intensive care, and 34 infants (35%) had redirection of intensive care. During this period, the proportion of death after redirection of care increased from 30.6% to 39.6%. Infants decided to forgo life-sustaining care before death had significantly lower gestational ages and lower birth weights (30.5 vs. 27.1 weeks, P=0.005; 1,528 vs. 1,063 g, P=0.025).
CONCLUSION
Infection remained an important cause of death for neonate, particularly for preterm infants. The proportion of infants who had redirectoin of care before death was increased, suggesting that quality-of-life should be considered an important factor in the decision-making process for the infant, parents, and medical staff.