{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T15:23:13Z","timestamp":1772119393213,"version":"3.50.1"},"reference-count":10,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T00:00:00Z","timestamp":1738886400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100005774","name":"Universitat de Barcelona","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100005774","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr"],"abstract":"\n Abstract<\/jats:title>\n The Surprise Question \u201cWould you be surprised if the patient died in the next 12\u00a0months?\u201d lacks pediatric research, particularly in neonatal patients. Our study aims to analyze the Surprise Question\u2019s predictive ability in neonates and explore pediatricians\u2019 views on palliative care patient identification. A prospective cross-sectional study was conducted from February 2021 to June 2023, including all newborns admitted to the Neonatal Intensive Care Unit of a pediatric tertiary hospital and its pediatricians. Patients with less than a year since admission were excluded from final analyses. Recorded variables included patient demographics and condition, pediatricians\u2019 profile and opinions regarding the Surprise Question, and palliative care patient identification. The Surprise Question was formulated to one or more pediatricians per neonate at admission, 7\u00a0days of life, and 28\u00a0days of life, with patient status recorded after 12\u00a0months to elaborate a confusion matrix of prognostic test results. A total of 51 pediatricians participated. Most felt they had limited criteria for identifying palliative care patients (55%), believed the Surprise Question could be useful (77%), and predicted death (75%). The Surprise Question was answered at least in one out of the three moments for 262 neonates (61% male and at least 36% preterm), with sufficient sample at each moment to study its predictive ability. High negative predictive values were consistent, with higher positive predictive value at 7\u00a0days (26%).<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The Surprise Question is a promising tool for predicting neonatal outcome and could guide professionals in initiating palliative care discussions. The 7-day mark appears more suitable for this application.\n \n \n \n \n \n What is Known:<\/jats:bold>\n \u2022 Previous research has established the Surprise Question as a valuable tool for predicting death in adults. However, limited research exists on its use in pediatric patients and its role remains unexplored in the neonatal period.<\/jats:italic>\n <\/jats:td>\n <\/jats:tr>\n \n \n What is New:<\/jats:bold>\n \u2022 The study evaluates the Surprise Question as a tool for predicting death within the first year of life when applied in the neonatal period. It offers insights into its predictive ability and most suitable time for its application. This study sheds light on its applicability in neonatal care, offering a valuable tool for early identification and referral to palliative care.<\/jats:italic>\n <\/jats:td>\n <\/jats:tr>\n <\/jats:tbody>\n <\/jats:table>\n <\/jats:table-wrap>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1007\/s00431-024-05879-8","type":"journal-article","created":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T02:26:19Z","timestamp":1738895179000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Analysis of the surprise question as a tool for predicting death in neonates"],"prefix":"10.1007","volume":"184","author":[{"given":"Silvia","family":"Asenjo","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7190-0653","authenticated-orcid":false,"given":"Aleix","family":"Soler-Garcia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ana","family":"Morillo-Palomo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Habimana-Jordana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Montserrat","family":"Guillen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catalina","family":"Bolanc\u00e9","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergi","family":"Navarro-Vilarrub\u00ed","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,2,7]]},"reference":[{"issue":"7","key":"5879_CR1","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.1177\/02692163221099116","volume":"36","author":"EVTJ Van Lummel","year":"2022","unstructured":"Van Lummel EVTJ, Letswaard L, Zuithoff NPA, Tjan DHT, Van Delden JJM (2022) The utility of the surprise question: a useful tool for identifying patients nearing the last phase of life? A systematic review and meta-analysis. Palliat Med 36(7):1023\u20131046. https:\/\/doi.org\/10.1177\/02692163221099116","journal-title":"Palliat Med"},{"key":"5879_CR2","doi-asserted-by":"publisher","unstructured":"Yarnell CJ, Jewell LM, Astell A, Pinto R, Devine LA, Detsky ME, et al. Observational study of agreement between attending and trainee physicians on the surprise question: \u201cWould you be surprised if this patient died in the next 12 months?\u201d PLoS One. 2021 Feb 1;16(2). https:\/\/doi.org\/10.1371\/journal.pone.0247571","DOI":"10.1371\/journal.pone.0247571"},{"issue":"2","key":"5879_CR3","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1089\/jpm.2017.0192","volume":"21","author":"K Ouchi","year":"2018","unstructured":"Ouchi K, Jambaulikar G, George NR, Xu W, Obermeyer Z, Aaronson EL et al (2018) The \u201csurprise question\u201d asked of emergency physicians may predict 12-month mortality among older emergency department patients. J Palliat Med 21(2):236\u2013240. https:\/\/doi.org\/10.1089\/jpm.2017.0192","journal-title":"J Palliat Med"},{"key":"5879_CR4","doi-asserted-by":"publisher","first-page":"484","DOI":"10.1503\/cmaj.160775\/-\/DC1","volume":"189","author":"J Downar","year":"2017","unstructured":"Downar J, Goldman R, Pinto R, Englesakis M, Adhikari NKJ (2017) The \u201csurprise question\u201d for predicting death in seriously ill patients: a systematic review and meta-analysis. CMAJ 189:484\u2013493. https:\/\/doi.org\/10.1503\/cmaj.160775\/-\/DC1","journal-title":"CMAJ"},{"key":"5879_CR5","doi-asserted-by":"publisher","unstructured":"White N, Kupeli N, Vickerstaff V, Stone P. How accurate is the \u201csurprise question\u201d at identifying patients at the end of life? A systematic review and meta-analysis. BMC Med. 2017 Aug 2;15(1). https:\/\/doi.org\/10.1186\/s12916-017-0907-4","DOI":"10.1186\/s12916-017-0907-4"},{"issue":"4","key":"5879_CR6","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1089\/jpm.2016.0313","volume":"20","author":"EJ Lilley","year":"2017","unstructured":"Lilley EJ, Gemunden SA, Kristo G, Changoor N, Scott JW, Rickerson E et al (2017) Utility of the \u201csurprise\u201d question in predicting survival among older patients with acute surgical conditions. J Palliat Med 20(4):420\u2013423. https:\/\/doi.org\/10.1089\/jpm.2016.0313","journal-title":"J Palliat Med"},{"issue":"2","key":"5879_CR7","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1177\/0269216317716061","volume":"32","author":"K Burke","year":"2018","unstructured":"Burke K, Coombes LH, Menezes A, Anderson AK (2018) The \u2018surprise\u2019 question in paediatric palliative care: a prospective cohort study. 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Brooks\/Cole, Belmont, CA","edition":"2"}],"container-title":["European Journal of Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-024-05879-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00431-024-05879-8\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00431-024-05879-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,18]],"date-time":"2025-02-18T22:05:18Z","timestamp":1739916318000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00431-024-05879-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,7]]},"references-count":10,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["5879"],"URL":"https:\/\/doi.org\/10.1007\/s00431-024-05879-8","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-4722947\/v1","asserted-by":"object"}]},"ISSN":["1432-1076"],"issn-type":[{"value":"1432-1076","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,7]]},"assertion":[{"value":"11 July 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 October 2024","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 November 2024","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 February 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"182"}}