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

Jessica T. Fry; Nana Matoba; Ankur Datta; Robert DiGeronimo; Carl H. Coghill; Girija Natarajan; Beverly Brozanski; Steven R. Leuthner; Jason Z. Niehaus; Amy Brown Schlegel; Anita Shah; Isabella Zaniletti; Thomas Bartman; Karna Murthy; Kevin M. Sullivan; Francine Dykes; Anthony Piazza; Gregory Sysyn; Allison Black; Ramasubbareddy Dhanireddy; Anne Hansen; Tanzeema Houssain; Gustave Falciglia; Beth Haberman; Breda Poindexter; Amy Nathan; Kristin Nelson; Paul Kingma; Stefanie Riddle; Stephanie Merhar; Heather Kaplan; Kristina Reber; Rashmin Savani; Luc Brion; Noorjahan Ali; Theresa Grover; Jonathan Nedrelow; Annie Chi; Yvette Johnson; Gautham Suresh; William Engle; Lora Simpson; Gregory Sokol; Eugenia Pallotto; Robert Lyle; Becky Rogers; Lisa Kelly; Steven Chin; Rachel Chapman; Jamie Limjoco; Lori Haack; David Durand; Jeanette Asselin; Art DHarlingue; Priscilla Joe; Jacquelyn Evans; Michael Padula; David Munson; Suzanne Touch; Tasmin Najaf; Rakesh Rao; Amit Mathur; Victor McKay; Mark Speziale; Brian Lane; Laural Moyer; Billie Short; Con Yee Ling; Shrena Patel; Michael Uhing; Lynne Willett; Nicole Birge; Rajan Wadhawan; Elizabeth Jacobsen-Misbe; Zeenia Billimoria; Kyong-Soon Lee; Michel Mikhael; Irfan Ahmad; CHNC

doi:10.1016/j.jpeds.2019.10.039

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

Journal article

Peer reviewed

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

Jessica T. Fry, Nana Matoba, Ankur Datta, Robert DiGeronimo, Carl H. Coghill, Girija Natarajan, Beverly Brozanski, Steven R. Leuthner, Jason Z. Niehaus, Amy Brown Schlegel, …

The Journal of pediatrics, Vol.217, pp.86-91.e1

01/02/2020

DOI: https://doi.org/10.1016/j.jpeds.2019.10.039

PMID: 31831163

Abstract

Life Sciences & Biomedicine

Pediatrics

Science & Technology

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.

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Title: Center, Gestational Age, and Race Impact End-of-Life Care Practices at Regional Neonatal Intensive Care Units
Creators - without role: Jessica T. Fry - Northwestern University
Nana Matoba - Northwestern University
Ankur Datta - Northwestern University
Robert DiGeronimo - University of Washington
Carl H. Coghill - University of Alabama at Birmingham
Girija Natarajan - Wayne State University
Beverly Brozanski - University of Pittsburgh
Steven R. Leuthner - Medical College of Wisconsin
Jason Z. Niehaus - Indiana University – Purdue University Indianapolis
Amy Brown Schlegel - Nationwide Children's Hospital
Anita Shah - Children's Hospital of Orange County
Isabella Zaniletti - Children's Hospital Association
Thomas Bartman - Nationwide Children's Hospital
Karna Murthy - Lurie Children's Hospital
Kevin M. Sullivan - Thomas Jefferson University
Francine Dykes - Childrens Healthcare Atlanta, Atlanta, GA USA
Anthony Piazza - Childrens Healthcare Atlanta, Atlanta, GA USA
Gregory Sysyn - Scottish Rite Freemasonry
Allison Black - Childrens Hosp Alabama, Birmingham, AL USA
Ramasubbareddy Dhanireddy - Le Bonheur Childrens Hosp, Memphis, TN USA
Anne Hansen - Childrens Hosp Boston, Boston, MA USA
Tanzeema Houssain - Childrens Hosp Boston, Boston, MA USA
Gustave Falciglia - Ann & Robert H Lurie Childrens Hosp Chicago, Chicago, IL 60611 USA
Beth Haberman - Cincinnati Childrens Hosp, Cincinnati, OH USA
Breda Poindexter - Cincinnati Childrens Hosp, Cincinnati, OH USA
Amy Nathan - Cincinnati Childrens Hosp, Cincinnati, OH USA
Kristin Nelson - Cincinnati Childrens Hosp, Cincinnati, OH USA
Paul Kingma - Cincinnati Childrens Hosp, Cincinnati, OH USA
Stefanie Riddle - Cincinnati Childrens Hosp, Cincinnati, OH USA
Stephanie Merhar - Cincinnati Childrens Hosp, Cincinnati, OH USA
Heather Kaplan - Cincinnati Childrens Hosp, Cincinnati, OH USA
Kristina Reber - Nationwide Childrens Hosp, Columbus, OH USA
Rashmin Savani - College Station Medical Center
Luc Brion - College Station Medical Center
Noorjahan Ali - College Station Medical Center
Theresa Grover - Childrens Hosp Colorado, Aurora, CO USA
Jonathan Nedrelow - Cook Childrens Hlth Care Syst, Ft Worth, TX USA
Annie Chi - Cook Childrens Hlth Care Syst, Ft Worth, TX USA
Yvette Johnson - Cook Childrens Hlth Care Syst, Ft Worth, TX USA
Gautham Suresh - Texas Childrens Hosp, Houston, TX 77030 USA
William Engle - Riley Childrens Hosp, Indianapolis, IN USA
Lora Simpson - Riley Childrens Hosp, Indianapolis, IN USA
Gregory Sokol - Riley Childrens Hosp, Indianapolis, IN USA
Eugenia Pallotto - Sisters of Mercy Health System
Robert Lyle - Arkansas Childrens Hosp, 800 Marshall St, Little Rock, AR 72202 USA
Becky Rogers - Arkansas Childrens Hosp, 800 Marshall St, Little Rock, AR 72202 USA
Lisa Kelly - Childrens Hosp Los Angeles, Los Angeles, CA 90027 USA
Steven Chin - Childrens Hosp Los Angeles, Los Angeles, CA 90027 USA
Rachel Chapman - Childrens Hosp Los Angeles, Los Angeles, CA 90027 USA
Jamie Limjoco - Amer Family Childrens Hosp, Madison, WI USA
Lori Haack - Amer Family Childrens Hosp, Madison, WI USA
David Durand - Childrens Hosp & Res Ctr Oakland, Oakland, CA USA
Jeanette Asselin - Childrens Hosp & Res Ctr Oakland, Oakland, CA USA
Art DHarlingue - Childrens Hosp & Res Ctr Oakland, Oakland, CA USA
Priscilla Joe - Childrens Hosp & Res Ctr Oakland, Oakland, CA USA
Jacquelyn Evans - Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Michael Padula - Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA
David Munson - Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA
Suzanne Touch - St Christophers Hosp Children, Philadelphia, PA 19133 USA
Tasmin Najaf - St Louis Childrens Hosp, St Louis, MO 63178 USA
Rakesh Rao - St Louis Childrens Hosp, St Louis, MO 63178 USA
Amit Mathur - St Louis Childrens Hosp, St Louis, MO 63178 USA
Victor McKay - All Childrens Hosp, St Petersburg, FL USA
Mark Speziale - Rady Childrens Hosp, San Diego, CA USA
Brian Lane - Rady Childrens Hosp, San Diego, CA USA
Laural Moyer - Rady Childrens Hosp, San Diego, CA USA
Billie Short - College Station Medical Center
Con Yee Ling - College Station Medical Center
Shrena Patel - College Station Medical Center
Michael Uhing - Childrens Hosp Wisconsin, Milwaukee, WI 53201 USA
Lynne Willett - Childrens Hosp Omaha, Omaha, NE USA
Nicole Birge - Childrens Hosp Omaha, Omaha, NE USA
Rajan Wadhawan - Florida Hosp Children, Orlando, FL USA
Elizabeth Jacobsen-Misbe - Seattle Childrens Hosp, Seattle, WA USA
Zeenia Billimoria - Seattle Childrens Hosp, Seattle, WA USA
Kyong-Soon Lee - Sick
Michel Mikhael - Childrens Hosp Orange Cty, Los Angeles, CA USA
Irfan Ahmad - Childrens Hosp Orange Cty, Los Angeles, CA USA
CHNC
Publication Details: The Journal of pediatrics, Vol.217, pp.86-91.e1
Publisher: Elsevier
Number of pages: 7
Identifiers: 9923887408331
Academic Unit: King Khalid University
Language: English
Resource Type: Journal article