Center, Gestational Age, and Race Impact End-of-Life Care Practices at Regional Neonatal Intensive Care Units

被引：16

作者：

Fry, Jessica T. ^{[1
,2
]}

Matoba, Nana ^{[1
,2
]}

Datta, Ankur ^{[1
,2
]}

DiGeronimo, Robert ^{[3
,4
]}

Coghill, Carl H. ^{[5
,6
]}

Natarajan, Girija ^{[7
,8
]}

Brozanski, Beverly ^{[9
,10
,22
,23
]}

Leuthner, Steven R. ^{[11
,12
]}

Niehaus, Jason Z. ^{[13
,14
]}

Schlegel, Amy Brown ^{[15
,16
]}

Shah, Anita ^{[17
]}

Zaniletti, Isabella ^{[18
]}

Bartman, Thomas ^{[15
,16
]}

Murthy, Karna ^{[1
,2
]}

Sullivan, Kevin M. ^{[19
,20
]}

Dykes, Francine ^{[24
]}

Piazza, Anthony ^{[24
]}

Sysyn, Gregory ^{[25
]}

Black, Allison ^{[26
]}

Dhanireddy, Ramasubbareddy ^{[27
]}

Hansen, Anne ^{[28
]}

Houssain, Tanzeema ^{[28
]}

Falciglia, Gustave ^{[29
]}

Haberman, Beth ^{[30
]}

Poindexter, Breda ^{[30
]}

Nathan, Amy ^{[30
]}

Nelson, Kristin ^{[30
]}

Kingma, Paul ^{[30
]}

Riddle, Stefanie ^{[30
]}

Merhar, Stephanie ^{[30
]}

Kaplan, Heather ^{[30
]}

Reber, Kristina ^{[31
]}

Savani, Rashmin ^{[32
]}

Brion, Luc ^{[32
]}

Ali, Noorjahan ^{[32
]}

Grover, Theresa ^{[33
]}

Nedrelow, Jonathan ^{[34
]}

Chi, Annie ^{[34
]}

Johnson, Yvette ^{[34
]}

Suresh, Gautham ^{[35
]}

Engle, William ^{[36
]}

Simpson, Lora ^{[36
]}

Sokol, Gregory ^{[36
]}

Pallotto, Eugenia ^{[37
]}

Lyle, Robert ^{[38
]}

Rogers, Becky ^{[38
]}

Kelly, Lisa ^{[39
]}

Chin, Steven ^{[39
]}

Chapman, Rachel ^{[39
]}

Limjoco, Jamie ^{[40
]}

机构：

[1] Ann & Robert H Lune Childrens Hosp Chicago, Div Neonatol, 225 E Chicago Ave,Box 45, Chicago, IL 60611 USA

[2] Northwestern Univ, Dept Pediat, Feinberg Sch Med, Chicago, IL 60611 USA

[3] Univ Washington, Dept Pediat, Seattle, WA 98195 USA

[4] Seattle Childrens Hosp, Div Neonatol, Seattle, WA USA

[5] Univ Alabama Birmingham, Dept Pediat, Birmingham, AL USA

[6] Childrens Alabama, Div Neonatol, Birmingham, AL USA

[7] Wayne State Univ, Dept Pediat, Detroit, MI 48202 USA

[8] Childrens Hosp Michigan, Div Neonatol, Detroit, MI 48201 USA

[9] Univ Pittsburgh, Dept Pediat, Pittsburgh, PA 15260 USA

[10] UPMC Childrens Hosp, Div Newborn Med, Pittsburgh, PA USA

[11] Med Coll Wisconsin, Dept Pediat, 8701 Watertown Plank Rd, Milwaukee, WI 53226 USA

[12] Childrens Hosp Wisconsin, Div Neonatol, Milwaukee, WI 53201 USA

[13] Indiana Univ, Dept Pediat, Indianapolis, IN 46204 USA

[14] Riley Hosp Children, Div Neonatol, Indianapolis, IN USA

[15] Ohio State Coll Med, Dept Pediat, Columbus, OH USA

[16] Nationwide Childrens Hosp, Div Neonatol, Columbus, OH USA

[17] Childrens Hosp Orange Cty, Div Neonatol, Orange, CA 92668 USA

[18] Childrens Hosp Assoc, Lenexa, KS USA

[19] Thomas Jefferson Univ, Sidney Kimmel Med Coll, Dept Pediat, Philadelphia, PA 19107 USA

[20] Nemours AI duPont Hosp Children, Div Neonatol, Wilmington, DE USA

[21] Childrens Hosp Neonatal Consortium, Kansas City, MO USA

[22] Washington Univ, Sch Med, Dept Pediat, St Louis, MO 63110 USA

[23] St Louis Childrens Hosp, Div Newborn Med, St Louis, MO 63178 USA

[24] Childrens Healthcare Atlanta, Atlanta, GA USA

[25] Childrens Healthcare Atlanta Scottish Rite, Atlanta, GA USA

[26] Childrens Hosp Alabama, Birmingham, AL USA

[27] Le Bonheur Childrens Hosp, Memphis, TN USA

[28] Childrens Hosp Boston, Boston, MA USA

[29] Ann & Robert H Lurie Childrens Hosp Chicago, Chicago, IL 60611 USA

[30] Cincinnati Childrens Hosp, Cincinnati, OH USA

[31] Nationwide Childrens Hosp, Columbus, OH USA

[32] Childrens Med Ctr, Dallas, TX 75235 USA

[33] Childrens Hosp Colorado, Aurora, CO USA

[34] Cook Childrens Hlth Care Syst, Ft Worth, TX USA

[35] Texas Childrens Hosp, Houston, TX 77030 USA

[36] Riley Childrens Hosp, Indianapolis, IN USA

[37] Childrens Mercy Hosp & Clin, Kansas City, MO USA

[38] Arkansas Childrens Hosp, 800 Marshall St, Little Rock, AR 72202 USA

[39] Childrens Hosp Los Angeles, Los Angeles, CA 90027 USA

[40] Amer Family Childrens Hosp, Madison, WI USA

[41] Childrens Hosp & Res Ctr Oakland, Oakland, CA USA

[42] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[43] St Christophers Hosp Children, Philadelphia, PA 19133 USA

[44] St Louis Childrens Hosp, St Louis, MO 63178 USA

[45] All Childrens Hosp, St Petersburg, FL USA

[46] Rady Childrens Hosp, San Diego, CA USA

[47] Childrens Natl Med Ctr, Washington, DC 20010 USA

[48] Primary Childrens Med Ctr, Salt Lake City, UT 84103 USA

[49] Childrens Hosp Wisconsin, Milwaukee, WI 53201 USA

[50] Childrens Hosp Omaha, Omaha, NE USA

来源：

JOURNAL OF PEDIATRICS | 2020年 / 217卷

关键词：

BLACK-AND-WHITE; CHILDRENS HOSPITALS; INFANTS; MORTALITY; OUTCOMES; RESUSCITATION; DISCUSSIONS; DISPARITIES; DEATH;

D O I：

10.1016/j.jpeds.2019.10.039

中图分类号：

R72 [儿科学];

学科分类号：

100202 ;

摘要：

Objective To assess the impact of intercenter variation and patient factors on end-of-life care practices for infants who die in regional neonatal intensive care units (NICUs). Study design We conducted a retrospective cohort analysis using the Children's Hospital Neonatal Database during 2010-2016. A total of 6299 nonsurviving infants cared for in 32 participating regional NICUs were included to examine intercenter variation and the effects of gestational age, race, and cause of death on 3 end-of-life care practices: do not attempt resuscitation orders (DNR), cardiopulmonary resuscitation within 6 hours of death (CPR), and withdrawal of life-sustaining therapies (WLST). Factors associated with these practices were used to develop a multivariable equation. Results Dying infants in the cohort underwent DNR (55%), CPR (21%), and WLST (73%). Gestational age, cause of death, and race were significantly and differently associated with each practice: younger gestational age (<28 weeks) was associated with CPR (OR 1.7, 95% CI 1.5-2.1) but not with DNR or WLST, and central nervous system injury was associated with DNR (1.6, 1.3-1.9) and WLST (4.8, 3.7-6.2). Black race was associated with decreased odds of WLST (0.7, 0.6-0.8). Between centers, practices varied widely at different gestational ages, race, and causes of death. Conclusions From the available data on end-of-life care practices for regional NICU patients, variability appears to be either individualized or without consistency.

引用

页码：86 / +

页数：7

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