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Arch Dis Child Fetal Neonatal Ed 94:F434-F438 doi:10.1136/adc.2008.149260
  • Original article

Analgesics, sedatives and neuromuscular blockers as part of end-of-life decisions in Dutch NICUs

  1. A A E Verhagen1,
  2. J H H M Dorscheidt2,
  3. B Engels1,
  4. J H Hubben2,
  5. P J Sauer1
  1. 1
    Department of Paediatrics, Beatrix Children’s Hospital/University Medical Centre Groningen, Groningen, the Netherlands
  2. 2
    Department of Health Sciences, Section of Health Law, University Medical Centre Groningen, Groningen, the Netherlands
  1. Correspondence to A A Eduard Verhagen, Beatrix Children’s Hospital/University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands; e.verhagen{at}bkk.umcg.nl
  • Accepted 2 June 2009
  • Published Online First 1 July 2009

Abstract

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.

Footnotes

  • 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.

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