[The perinatal palliative care development through the years: a longitudinal study].

Abstract

Advances in perinatal medicine have contributed to significantly improved survival of newborns. While some infants die despite extensive medical treatment, a larger proportion dies after a decision to withdraw life-sustaining therapy is made. The approaches to these decisions have significantly changed over the years, and their practical implementation still varies greatly between different neonatal intensive care units. The aim of this study was to evaluate the circumstances surrounding all neonatal deaths in a university neonatal setting in Germany over a ten-year period and to document changes over time. During the 10-year study period, 41,543 children were born at the LMU university hospital Munich, while 348 children died during this time. Of these, 248 children passed away in the delivery room. A total of 10,908 children received medical care in the neonatal wards (two level III NICUs and two intermediate care units). Of these, more than half (56%) were term infants, and only about 1% wereat the border of viability. On the neonatal intensive care unit, a total of 97 newborns died. A more proactive approach has led to primary palliative care for extremely preterm infants being increasingly replaced by attempts at therapy at the threshold of viability. Since there was no change in the guidelines for the management of preterm infants at the border of viability during the data collection period, this shift could be attributed more likely to the interaction of parental preferences and expectations and medical decision-making.