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Outcomes of Preterm Infants following Discussions about Withdrawal or Withholding of Life Support

Journal title
The Journal of pediatrics
Publication year
James, J.; Munson, D.; DeMauro, S. B.; Langer, J. C.; Dworetz, A. R.; Natarajan, G.; Bidegain, M.; Fortney, C. A.; Seabrook, R.; Vohr, B. R.; Tyson, J. E.; Bell, E. F.; Poindexter, B. B.; Shankaran, S.; Higgins, R. D.; Das, A.; Stoll, B. J.; Kirpalani, H.

OBJECTIVES: To describe the frequency of postnatal discussions about withdrawal or withholding of life-sustaining therapy (WWLST), ensuing WWLST, and outcomes of infants surviving such discussions. We hypothesized that such survivors have poor outcomes. STUDY DESIGN: This retrospective review included registry data from 18 centers of the National Institute of Child Health and Human Development Neonatal Research Network. Infants born at 22-28 weeks of gestation who survived >12 hours during 2011-2013 were included. Regression analysis identified maternal and infant factors associated with WWLST discussions and factors predicting ensuing WWLST. In-hospital and 18- to 26-month outcomes were evaluated. RESULTS: WWLST discussions occurred in 529 (15.4%) of 3434 infants. These were more frequent at 22-24 weeks (27.0%) compared with 27-28 weeks of gestation (5.6%). Factors associated with WWLST discussion were male sex, gestational age (GA) of 25 years, necrotizing enterocolitis, and days on a ventilator. CONCLUSIONS: Wide center variations in WWLST discussions occur, especially at

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