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Withdrawal of artificial nutrition and hydration: a survey of level IV neonatal intensive care units

Journal of Perinatology volume 41, pages 2372–2374 (2021)Cite this article

Subjects

The withdrawal of artificial nutrition and hydration (WANH) is a rare and largely unexplored aspect of neonatal palliative care. In 2009, an AAP report with contributions from the Committee on Bioethics concluded that WANH is considered “ethically acceptable in limited circumstances” [1]. In 2011, a survey of neonatologists revealed that controversy remains surrounding WANH, despite being deemed ethically acceptable, with approximately one in three neonatal providers stating they would not offer WANH because of pain and suffering concerns [2]. At this time, data on the process and frequency of WANH are absent from the medical literature. To this end, we sought to capture recent rates and perspectives regarding WANH in Children’s Hospitals Neonatal Consortium (CHNC) NICUs.

The CHNC shares information from 34 level IV NICUs across North America to learn about existing practices and improve care. An electronic survey was sent to site sponsors at each of the 34 CHNC NICUs. One representative from each site had 8 weeks to respond to the survey based upon individual recall and their site’s available tracking data; however, no external validation data were available. Data were collected using REDCap [3, 4] and deemed IRB exempt.

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References

  1. Diekema DS, Botkin JR, Committee on Bioethics. Clinical report-Forgoing medically provided nutrition and hydration in children. Pediatrics. 2009;124:813–22.

    Article  Google Scholar 

  2. Feltman DM, Du H, Leuthner SR. Survey of neonatologists’ attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit. J Perinatol. 2012;32:886–92.

    Article  CAS  Google Scholar 

  3. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)-a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–81.

    Article  Google Scholar 

  4. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. REDCap Consortium. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.

    Article  Google Scholar 

  5. Hellmann J, Williams C, Ives-Baine L, Shah PS. Withdrawal of artificial nutrition and hydration in the neonatal intensive care unit: parental perspectives. Arch Dis Child Fetal Neonatal Ed. 2013;98:F21–5.

    Article  Google Scholar 

  6. Vesely C, Beach B. One facility’s experience in reframing nonfeeding into a comprehensive palliative care model. J Obstet Gynecol Neonatal Nurs. 2013;42:383–9.

    Article  Google Scholar 

Download references

Acknowledgements

We thank the institutions within the Children’s Hospitals Neonatal Consortium for their care of neonates and families and for their investment in sharing knowledge within this consortium.

Children’s Hospitals Neonatal Consortium (CHNC)

Anthony Piazza24, Gregory Sysyn25, Allison Black26, Carl Coghill26, Anne Hansen27, Gustave Falciglia28, Beth Haberman29, Kris Reber30, Luc Brion31, Rashmin Savani31, Theresa Grover32, Girija Natarajan33, Annie Chi34, Annmarie Giolioto35, Lakshmi Katakam36, Bill Engle37, Lora Simpson37, Julie Lindower38, Julie Weiner39, Becky Rogers40, Rachel Chapman41, Steven Chin41, Jamie Limjoco42, Mark Weems43, Michael Uhing44, Priscilla Joe45, Trent Tipple46, Patricia Williams46, Nicole Birge47, Lynne Willett47, Narendra Dereddy48, Rajan Wadhawan48, Darlene Calhoun49, Caroline Chua49, Mike Padula50, Vilmaris Quinones51, Toby Yanowitz52, Con Yee Ling53, Mark Speziale54, Robert DiGeronimo55, Elizabeth Jacobsen55, Beverly Brozanski56, Rakesh Rao56, Victor McKay57, Kyong Soon58, Billie Short59, Kevin Sullivan60, Cherrie Welch61

Author information

Authors and Affiliations

  1. Department of Pediatrics and Division of Neonatology, Harbor-UCLA Medical Center, Torrance, CA, USA

    Robin Saoud

  2. Division of Neonatology, Children’s Hospital of Orange County, Orange, CA, USA

    Robin Saoud & Anita Shah

  3. Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, USA

    Devika Locke & Kevin M. Sullivan

  4. Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Devika Locke

  5. Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Jessica T. Fry, Nana Matoba & Ankur Datta

  6. Division of Neonatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA

    Jessica T. Fry, Nana Matoba & Ankur Datta

  7. Department of Pediatrics, University of Washington, Seattle, WA, USA

    Robert DiGeronimo

  8. Division of Neonatology, Seattle Children’s Hospital, Seattle, WA, USA

    Robert DiGeronimo

  9. Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA

    Steven R. Leuthner

  10. Division of Neonatology, Children’s Wisconsin, Milwaukee, WI, USA

    Steven R. Leuthner

  11. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA

    Carl H. Coghill

  12. Division of Neonatology, Children’s of Alabama, Birmingham, AL, UK

    Carl H. Coghill

  13. Department of Pediatrics, Central Michigan University, Detroit, MI, USA

    Girija Natarajan

  14. Division of Neonatology, Children’s Hospital of Michigan, Detroit, MI, USA

    Girija Natarajan

  15. Department of Pediatrics, Indiana University, Indianapolis, IN, USA

    Jason Z. Niehaus

  16. Division of Neonatology, Riley Hospital for Children, Indianapolis, IN, USA

    Jason Z. Niehaus

  17. Department of Pediatrics, The Ohio State College of Medicine, Columbus, OH, USA

    Amy Brown Schlegel

  18. Division of Neonatology, Nationwide Children’s Hospital, Columbus, OH, USA

    Amy Brown Schlegel

  19. Department of Pediatrics at University of Missouri – Kansas City, Kansas City, MO, USA

    Julie Weiner

  20. Division of Neonatology, Children’s Mercy Kansas City, Kansas City, MO, USA

    Julie Weiner

  21. Department of Pediatrics, University of Central Florida, Orlando, FL, USA

    Narendra Dereddy

  22. Division of Neonatology, AdventHealth for Children, Orlando, FL, USA

    Narendra Dereddy

  23. Division of Neonatology, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA

    Kevin M. Sullivan

  24. CHOA Egleston, Atlanta, GA, USA

    Anthony Piazza

  25. CHOA Scottish Rite, Atlanta, GA, USA

    Gregory Sysyn

  26. Children’s Hospital Alabama, Birmingham, AL, USA

    Allison Black & Carl Coghill

  27. Boston Children’s Hospital, Boston, MA, USA

    Anne Hansen

  28. Lurie Children’s Hospital, Chicago, IL, USA

    Gustave Falciglia

  29. Cincinnati Children’s Hospital, Cincinnati, OH, USA

    Beth Haberman

  30. Nationwide Children’s Hospital, Columbus, OH, USA

    Kris Reber

  31. Children’s Medical Center, Dallas, TX, USA

    Luc Brion & Rashmin Savani

  32. Children’s Hospital Colorado, Aurora, CO, USA

    Theresa Grover

  33. Children’s Hospital Michigan, Detroit, MI, USA

    Girija Natarajan

  34. Cook Children’s Medical Center, Fort Worth, TX, USA

    Annie Chi

  35. Connecticut Children’s Hospital, Hartford, CT, USA

    Annmarie Giolioto

  36. Texas Children’s Hospital, Houston, TX, USA

    Lakshmi Katakam

  37. Riley Children’s Hospital, Indianapolis, IN, USA

    Bill Engle & Lora Simpson

  38. University of Iowa Stead Family Children’s Hospital, Iowa City, IA, USA

    Julie Lindower

  39. Children’s Mercy - Kansas City, Kansas City, MO, USA

    Julie Weiner

  40. Arkansas Children’s Hospital, Little Rock, AR, USA

    Becky Rogers

  41. Children’s Hospital Los Angeles, Los Angeles, CA, USA

    Rachel Chapman & Steven Chin

  42. American Family Children’s Hospital, Madison, WI, USA

    Jamie Limjoco

  43. Le Bonheur Children’s Hospital, Memphis, TN, USA

    Mark Weems

  44. Children’s Wisconsin, Milwaukee, WI, USA

    Michael Uhing

  45. UCSF Benioff Children’s Hospital, Oakland, CA, USA

    Priscilla Joe

  46. The Children’s Hospital at OU Medicine, Oklahoma City, OK, USA

    Trent Tipple & Patricia Williams

  47. Omaha Children’s Hospital, Omaha, NE, USA

    Nicole Birge & Lynne Willett

  48. AdventHealth for Children, Orlando, FL, USA

    Narendra Dereddy & Rajan Wadhawan

  49. Nemours Children’s Hospital, Orlando, FL, USA

    Darlene Calhoun & Caroline Chua

  50. Children’s Hospital Of Philadelphia, Philadelphia, PA, USA

    Mike Padula

  51. St. Christopher’s Hospital for Children, Philadelphia, PA, USA

    Vilmaris Quinones

  52. UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA

    Toby Yanowitz

  53. Primary Children’s Hospital, Salt Lake City, UT, USA

    Con Yee Ling

  54. Rady Children’s Hospital, San Diego, CA, USA

    Mark Speziale

  55. Seattle Children’s Hospital, Seattle, WA, USA

    Robert DiGeronimo & Elizabeth Jacobsen

  56. St. Louis Children’s Hospital, One Children’s Place, St. Louis, MO, USA

    Beverly Brozanski & Rakesh Rao

  57. All Children’s Hospital, St. Petersburg, FL, USA

    Victor McKay

  58. The Hospital for Sick Children, Totronto, ON, Canada

    Kyong Soon

  59. Children’s National Hospital, Washington, DC, USA

    Billie Short

  60. Nemours/AI duPont Hospital, Wilmington, DE, USA

    Kevin Sullivan

  61. Brenner Children’s Hospital, Wake Forest Baptist Medical Center Medical Center Boulevard, Winston-Salem, NC, USA

    Cherrie Welch

Authors
  1. Robin Saoud
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  2. Devika Locke
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  3. Jessica T. Fry
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  4. Nana Matoba
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  5. Ankur Datta
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  6. Robert DiGeronimo
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  7. Steven R. Leuthner
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  8. Carl H. Coghill
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  9. Girija Natarajan
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  10. Jason Z. Niehaus
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  11. Amy Brown Schlegel
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  12. Julie Weiner
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  13. Narendra Dereddy
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  14. Anita Shah
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  15. Kevin M. Sullivan
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Consortia

on behalf of the Children’s Hospitals Neonatal Consortium (CHNC)

  • Anthony Piazza
  • , Gregory Sysyn
  • , Allison Black
  • , Carl Coghill
  • , Anne Hansen
  • , Gustave Falciglia
  • , Beth Haberman
  • , Kris Reber
  • , Luc Brion
  • , Rashmin Savani
  • , Theresa Grover
  • , Girija Natarajan
  • , Annie Chi
  • , Annmarie Giolioto
  • , Lakshmi Katakam
  • , Bill Engle
  • , Lora Simpson
  • , Julie Lindower
  • , Julie Weiner
  • , Becky Rogers
  • , Rachel Chapman
  • , Steven Chin
  • , Jamie Limjoco
  • , Mark Weems
  • , Michael Uhing
  • , Priscilla Joe
  • , Trent Tipple
  • , Patricia Williams
  • , Nicole Birge
  • , Lynne Willett
  • , Narendra Dereddy
  • , Rajan Wadhawan
  • , Darlene Calhoun
  • , Caroline Chua
  • , Mike Padula
  • , Vilmaris Quinones
  • , Toby Yanowitz
  • , Con Yee Ling
  • , Mark Speziale
  • , Robert DiGeronimo
  • , Elizabeth Jacobsen
  • , Beverly Brozanski
  • , Rakesh Rao
  • , Victor McKay
  • , Kyong Soon
  • , Billie Short
  • , Kevin Sullivan
  •  & Cherrie Welch

Contributions

AS and KMS generated the concept. RS, KMS, and AS created the survey. JTF, NM, AD, RD, SRL, CC, GN, JN, ABS, JW, and ND provided critical revision. RS, DL, AS, and KMS contributed to the data analysis, writing of the manuscript, and its critical revision.

Corresponding author

Correspondence to Kevin M. Sullivan.

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Conflict of interest

The author declares no competing interests.

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Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Members of the Children’s Hospitals Neonatal Consortium (CHNC) are listed below Acknowledgements.

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Cite this article

Saoud, R., Locke, D., Fry, J.T. et al. Withdrawal of artificial nutrition and hydration: a survey of level IV neonatal intensive care units. J Perinatol 41, 2372–2374 (2021). https://doi.org/10.1038/s41372-021-01011-y

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  • DOI: https://doi.org/10.1038/s41372-021-01011-y

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