Presenter Status
Resident/Psychology Intern
Abstract Type
Research
Primary Mentor
Jotishna Sharma
Start Date
13-5-2024 11:30 AM
End Date
13-5-2024 1:30 PM
Presentation Type
Poster Presentation
Description
Background
Modes of neonatal mortality include withdrawal of life-sustaining interventions, non-escalation of interventions, and secondary to a code event. Mortality trends have been examined broadly, but the impact of clinical and demographic factors on the mode of neonatal mortality has yet to be evaluated. A greater understanding of this information would help guide medical decision-making and identify potential inequities. The aim is to evaluate the impact of clinical and demographic factors on the mode of neonatal death in a level IV neonatal intensive care unit (NICU).
Study Design/Methods
Data were collected via retrospective chart review of patients who died at the Children’s Mercy Hospital NICU from January 2012-December 2022. Receiving CPR was defined as PALS or NRP-based intervention, outside of routine delivery room resuscitation, within six hours of death. Clinical instability was defined as needing vasoactive and/or invasive respiratory support. Statistical analysis was done using multinomial logistic regression models; for variables with more than two options, the largest group was designated as the reference.
Results
Over the 11-year period, there were 10,862 admissions and 563 (5.2%) deaths. Data were available for 561 deaths. 65% of deaths had interventions withdrawn, 23.2% had intervention withheld, and 11.8% received CPR. Demographic and hospital course data are shown in Tables 1 and 2. There was a significant difference in mode of neonatal death associated with race, diagnosis, and gestational age (GA). Black infants had increased odds of receiving CPR (OR=3.3 vs. withdrawn, OR=2.1 vs. withheld) compared to white infants. For every one week increase in GA, the odds of withdrawal vs. receiving CPR increased by 11%, and the odds of non-escalation vs. CPR increased by 12%. In the multivariate model, clinical factors such as stability prior to death, involvement of the prenatal fetal health program, and GA continued to show significant association, with higher GA being associated with a higher likelihood of withdrawal of care (Table 3).
Conclusion
In this large cohort of level IV NICU deaths, withdrawal of life-sustaining interventions is the commonest mode of death, and premature infants were more likely to receive CPR or non-escalation of interventions.
Included in
Higher Education and Teaching Commons, Medical Education Commons, Palliative Care Commons, Pediatrics Commons, Science and Mathematics Education Commons
How Neonates Die: Mortality Trends and Associations in a Level IV Neonatal Intensive Care Unit
Background
Modes of neonatal mortality include withdrawal of life-sustaining interventions, non-escalation of interventions, and secondary to a code event. Mortality trends have been examined broadly, but the impact of clinical and demographic factors on the mode of neonatal mortality has yet to be evaluated. A greater understanding of this information would help guide medical decision-making and identify potential inequities. The aim is to evaluate the impact of clinical and demographic factors on the mode of neonatal death in a level IV neonatal intensive care unit (NICU).
Study Design/Methods
Data were collected via retrospective chart review of patients who died at the Children’s Mercy Hospital NICU from January 2012-December 2022. Receiving CPR was defined as PALS or NRP-based intervention, outside of routine delivery room resuscitation, within six hours of death. Clinical instability was defined as needing vasoactive and/or invasive respiratory support. Statistical analysis was done using multinomial logistic regression models; for variables with more than two options, the largest group was designated as the reference.
Results
Over the 11-year period, there were 10,862 admissions and 563 (5.2%) deaths. Data were available for 561 deaths. 65% of deaths had interventions withdrawn, 23.2% had intervention withheld, and 11.8% received CPR. Demographic and hospital course data are shown in Tables 1 and 2. There was a significant difference in mode of neonatal death associated with race, diagnosis, and gestational age (GA). Black infants had increased odds of receiving CPR (OR=3.3 vs. withdrawn, OR=2.1 vs. withheld) compared to white infants. For every one week increase in GA, the odds of withdrawal vs. receiving CPR increased by 11%, and the odds of non-escalation vs. CPR increased by 12%. In the multivariate model, clinical factors such as stability prior to death, involvement of the prenatal fetal health program, and GA continued to show significant association, with higher GA being associated with a higher likelihood of withdrawal of care (Table 3).
Conclusion
In this large cohort of level IV NICU deaths, withdrawal of life-sustaining interventions is the commonest mode of death, and premature infants were more likely to receive CPR or non-escalation of interventions.
