Limits of Human Viability in the United States: A Medicolegal Review

Arzuaga, Bonnie H.; Lee, Ben Hokew

doi:10.1542/peds.2011-1689

Cited by 20 publications

(14 citation statements)

References 30 publications

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“…For example, we found an increase in gestational age and admission to a neonatal intensive care unit (NICU) at birth decreases the risk of neonatal death, which was also noted in previous studies that assessed neonatal mortality (Cifuentes et al, 2002;Bacak, Baptiste-Roberts, Amon, Ireland, and Leet (2005). It is important to note that for infants born near the lower gestational age limits of viability, the physician's decision to admit to the NICU at birth may have depended on factors such as the likelihood of survival and the appropriateness of intervention (Arzuaga & Lee, 2011). Therefore, NICU admission at birth may be in favor of neonates born closer to term with promising survivability.…”

Section: Discussionsupporting

confidence: 78%

Geographic Accessibility to Health Services and Neonatal Mortality Among Very-Low Birthweight Infants in South Carolina

Featherstone

Eberth

Nitcheva

et al. 2016

Matern Child Health J

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Section: Discussionsupporting

confidence: 78%

Geographic Accessibility to Health Services and Neonatal Mortality Among Very-Low Birthweight Infants in South Carolina

Featherstone

Eberth

Nitcheva

et al. 2016

Matern Child Health J

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“…23,24 Active withdrawal of treatment is common in NICUs in Europe, and half of neonatal deaths occur with this approach in the United Kingdom, 25 France, 26 the Netherlands, 27 Switzerland, 6,28,29 and Germany. 9 In a multicenter survey 7 assessing physician's end-of-life decisions in NICUs across 7 European countries, physicians from all these countries were found to have "set limits to intensive interventions," including continuation of current treatment without escalation, withholding of emergency treatment, and withholding of intensive treatment (the latter with the exception of Italy).…”

Section: Figurementioning

confidence: 99%

Neonatal End-of-Life Care: A Single-Center NICU Experience in Israel Over a Decade

2013

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WHAT'S KNOWN ON THIS SUBJECT: Neonatal mortality rate and causes of death have been relatively stable in recent years. Decision-making practices preceding death of sick neonates affect the circumstances of death. These practices vary worldwide according to the team approach and local population background.WHAT THIS STUDY ADDS: Although our population is mostly religious, we observed a decline in maximal intensive care along with increasing redirection of care over a decade. Changes in the team approach and increasing level of parental involvement influence type and duration of treatment.abstract OBJECTIVES: To follow changes in the causes of neonatal deaths in the NICU at Hadassah Medical Center, Jerusalem, Israel, over a decade; to examine trends regarding types of end-of-life-care provided (primary nonintervention, maximal intensive, and redirection of intensive care, including limitation of care and withdrawal of life-sustaining treatment); and to assess the parental role in the decision-making process given that the majority of the population is religious. METHODS:All neonates who died between 2000 and 2009 were identified. The causes and circumstances of death were abstracted from the medical records. Trends in end-of-life decisions were compared between 2 time periods:

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“…1,[4][5][6][7][8][9][10][11][12][13][14] Similarly, resuscitation practices at <26 weeks vary greatly by country, hospital, and practitioner 4,9,11,15 because there is no consensus on a precise "limit of viability" (defined as anywhere between 22 and 26 weeks). [16][17][18] The summary from a 2013 joint workshop held by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for MaternalFetal Medicine, the American Academy of Pediatrics, and the American College of Obstetricians and Gynecologists acknowledged the wide variation in practices and outcomes for infants born at <26 weeks' gestation. The workshop recommended that new population-based obstetric and newborn cohort studies investigate neonatal resuscitation practices and outcomes of extremely preterm infants.…”

mentioning

confidence: 99%

Survival and Major Morbidity of Extremely Preterm Infants: A Population-Based Study

et al. 2016

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OBJECTIVES: To assess the rates of mortality and major morbidity among extremely preterm infants born in California and to examine the rates of neonatal interventions and timing of death at each gestational age. METHODS:A retrospective cohort study of all California live births from 2007 through 2011 linked to vital statistics and hospital discharge records, whose best-estimated gestational age at birth was 22 through 28 weeks. Major morbidities were based on International Classification of Diseases, Ninth Revision, Clinical Modification codes. Survival beyond the first calendar day of life and procedure codes were used to assess attempted resuscitation after birth. RESULTS:A total of 6009 infants born at 22 through 28 weeks' gestation were included. Survival to 1 year for all live births ranged from 6% at 22 weeks to 94% at 28 weeks. Seventy-three percent of deaths occurred within the first week of life. Major morbidity was present in 80% of all infants, and multiple major morbidities were present in 66% of 22-and 23-week infants. Rates of resuscitation at 22, 23, and 24 weeks were 21%, 64%, and 93%, respectively. Survival after resuscitation was 31%, 42%, and 64% among 22-, 23-, and 24-week infants, respectively. Improved survival was associated with increased birth weight, female sex, and cesarean delivery (P < .01) for resuscitated 22-, 23-, and 24-week infants. CONCLUSIONS:In a population-based study of extreme prematurity, infants ≤24 weeks' gestation are at highest risk of death or major morbidity. These data can help inform recommendations and decision-making for extremely preterm births.

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Limits of Human Viability in the United States: A Medicolegal Review

Cited by 20 publications

References 30 publications

Geographic Accessibility to Health Services and Neonatal Mortality Among Very-Low Birthweight Infants in South Carolina

Geographic Accessibility to Health Services and Neonatal Mortality Among Very-Low Birthweight Infants in South Carolina

Neonatal End-of-Life Care: A Single-Center NICU Experience in Israel Over a Decade

Survival and Major Morbidity of Extremely Preterm Infants: A Population-Based Study

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