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Infant mode of death in the neonatal intensive care unit: A systematic scoping review

Journal of Perinatology volume 42, pages 551–568 (2022)Cite this article

Subjects

Abstract

Objective

To characterize literature that describes infant mode of death and to clarify how limitation of life-sustaining treatment (LST) is defined and rationalized.

Study design

Eligible studies were peer-reviewed, English-language, and included number of infant deaths by mode out of all infant deaths in the NICU and/or delivery room.

Result

58 included studies were primarily published in the last two decades from North American and European centers. There was variation in rates of infant mode of death by study, with some showing an increase in deaths following limitation of LST over time. Limitation of LST was defined by the intervention withheld/withdrawn, the relationship between the two practices, and prior frameworks. Themes for limiting LST included diagnoses, low predicted survival and/or quality of life, futility, and suffering.

Conclusion

Limitation of LST is a common infant mode of death, although rates, study definitions, and clinical rationale for this practice are variable.

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Fig. 1: PRISMA-ScR flow diagram.

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Acknowledgements

We would like to thank Chloe Rotman, MLIS, Manager of Library Services at Boston Children’s Hospital, for her assistance with the early phases of this scoping review, including search strategy and Covidence.

Funding

Cummings is supported by a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health under award number R01HD094794 (CC PI). This funder played no role in the study design, analysis, or preparation of this article. The other authors received no other external funding for this study.

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Authors and Affiliations

  1. Boston Children’s Hospital, Division of Newborn Medicine, Boston, MA, USA

    Matthew Lin & Christy Cummings

  2. Dana-Farber Cancer Institute, Department of Psychosocial Oncology and Palliative Care and Department of Pediatrics, Boston Children’s Hospital, Boston, USA

    Rachel Deming & Joanne Wolfe

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Contributions

ML and RD conceptualized and designed the study, designed the data collection protocol, collected the data, carried out the qualitative analyses, drafted the initial manuscript, and reviewed and revised the manuscript. CC and JW conceptualized and designed the study, supervised the data collection and qualitative analyses, and critically reviewed the manuscript for intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Matthew Lin.

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Lin, M., Deming, R., Wolfe, J. et al. Infant mode of death in the neonatal intensive care unit: A systematic scoping review. J Perinatol 42, 551–568 (2022). https://doi.org/10.1038/s41372-022-01319-3

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