390 - End of life care for newborn infants in Argentina. Prospective multicenter study

Poster Number: 390
Publication Number: 390.134

Gonzalo L. Mariani, Hospital Italiano de Buenos Aires, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina; Pamela J. Contrera, UNNE, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina; Ariel L. Fernandez, Hardineros, Ramos Mejía, Buenos Aires, Argentina; Aldana S. Avila, Sanatorio de la Trinidad, Buenos Aires, Buenos Aires, Argentina; María de los Angeles Virasoro, Universidad de Buenos Aires, Tandil, Buenos Aires, Argentina; Ines Urquizu, Universidad San Francisco Xavie de Chuquisaca, Buenos Aires, Buenos Aires, Argentina; Constanza Portela, Universidad de Buenos Aires, Ciudad autónoma de buenos aires, Ciudad Autonoma de Buenos Aires, Argentina; Patricia Fernandez Riera, Hospital Universitario Buenos Aires (UBA) (medicine college, Capital Federal, Buenos Aires, Argentina; Gustavo R. Cardigni, Sanatorio de la Trinidad Palermo, Buenos Aires, Buenos Aires, Argentina; Nestor E. Vain, School of Medicine, University of Buenos Aires, CIUDAD DE BUENOS AIRES, Ciudad Autonoma de Buenos Aires, Argentina

Background: Most neonatal deaths in industrialized countries follow a process of adequacy of care (withholding-WH-/ withdrawal-WD-). Little is known about how end-of-life care is provided in Argentina, both in the delivery room (DR) and in the Neonatal Intensive Care Unit (NICU)

Objective: To describe how neonates die in Argentina and to analyze factors involved in the decision-making process

Design/Methods: Prospective, multicenter, observational study. Neonates ≥ 22 weeks gestational age who died in the DR or in the NICU in 104 Level 3 or higher Neonatal Units of all the country were included. One investigator at each Center conducted an interview after each neonatal death with a member of the health care team who had been involved in the end-of-life care. Perinatal data, conditions that led to death, whether there was adequacy of care and details of the end-of-life process were recorded anonymously to guarantee the confidentiality of the data. The protocol was approved by the Research Ethics Committee of each participating hospital. Z test of proportions was used, and a multivariate logistic regression was performed to identify factors independently associated with adequacy of care

Results: From May 1 to October 31, 2021, 588 neonates died in the centers involved, 526 in the NICU and 62 in the DR. Main causes of death were complications of prematurity (46%) and congenital anomalies (25%). Overall, 30% of neonates died after a process of adequacy of care, and this was lower in the NICU (25%) than in the DR (73%, difference in proportions 0,48 95%CI 0,35-0,61, p < 0.001). The reason for WH/WD care was an imminent or inevitable death in 75% of cases and severe compromise of quality of life in 25%. Adequacy consisted in WH resuscitation/ do not add new therapies in 67% and active WD of life sustaining therapies in 33%. Multivariable analysis showed that a diagnosis of a major congenital anomaly increased the odds of adequacy (OR 6.6; 95%CI 4.3-10.3) while being assisted in a Public Hospital decreased those odds (OR 0.43; 95%CI 0.26-0.69). Within patients whose death followed a process of adequacy of care, parents were involved in the decision in 74% of the cases, the nursing team in 51% and palliative care specialists were involved in 19%. 92% of parents were offered to hold their child at the end and 91% of them accepted to do soConclusion(s): Most neonates who die in NICUs in Argentina do so while receiving full support. A small percentage of WD of support are secondary to quality-of-life compromise. Decisions about WH or WD intensive care remain a major challenge