Analgesics, sedatives and neuromuscular blockers as part of end-of-life decisions in Dutch NICUs
- 1Department of Paediatrics, Beatrix Children’s Hospital/University Medical Centre Groningen, Groningen, the Netherlands
- 2Department of Health Sciences, Section of Health Law, University Medical Centre Groningen, Groningen, the Netherlands
- Correspondence to A A Eduard Verhagen, Beatrix Children’s Hospital/University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands;
- Accepted 2 June 2009
- Published Online First 1 July 2009
Background: Clinicians frequently administer analgesics and sedatives at the time of withholding or withdrawal of life-sustaining treatment in newborns. This practice might be regarded as intentionally hastening of death.
Objective: To describe type, doses and reasons for administering medications as part of end-of-life decisions in the Dutch neonatal intensive care units.
Design and setting: We reviewed the medical files of 340 newborn deaths with a preceding end-of-life decision over a 12-month period to describe the use of analgesics, sedatives and/or neuromuscular blockers. The neonatologists of 147 of the 150 newborns with a preceding end-of-life decision based on the infant’s poor prognosis were interviewed to obtain additional details about the use of medication.
Results: Analgesics and sedatives were administered to 224 of 340 newborns before the end-of-life decision and to 292 newborns after the decision. The medication was increased in 94 of 289 newborns whose death was imminent and in 110 of 150 newborns with a poor prognosis. Reasons for the increase were treatment of pain and suffering, and in 4% of cases hastening of death. Reasons were undocumented in 55% of deaths. Neuromuscular blockers were administered in 16% of patients because they already received these agents or to stop or prevent gasping.
Conclusions: Analgesics and sedatives are generally increased after the end-of-life decision to treat pain and suffering and rarely to hasten death. Neuromuscular blockers were administered in 16% of deaths. Medical files provide insufficient documentation of considerations leading to the increase of medication, which hinders (external) review.
Funding This study was sponsored by the Dutch Ministry of Health, Welfare and Sport.
Competing interests None.
Provenance and Peer review Not commissioned; externally peer reviewed.