{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T02:17:48Z","timestamp":1787969868014,"version":"build-2784847793"},"reference-count":33,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,12,10]],"date-time":"2022-12-10T00:00:00Z","timestamp":1670630400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["203132\/Z\/16\/Z"],"award-info":[{"award-number":["203132\/Z\/16\/Z"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>Death in the neonatal intensive care unit (NICU) commonly follows a decision to withdraw or limit life\u2010sustaining treatment. Advances in medicine have changed the nature of life\u2010sustaining interventions available and the potential prognosis for many newborn conditions. We aimed to assess changes in causes of death and end\u2010of\u2010life care over nearly four decades.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A retrospective review of infants dying in the NICU was performed (2017\u20132020) and compared with previous audits performed in the same centre (1985\u20131987 and 1999\u20132001). Diagnoses at death were recorded for each infant as well as their apparent prognosis and any withdrawal or limitations of medical treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the recent epoch, there were 88 deaths out of 2084 admissions (4.2%), a reduction from the previous epochs (132\/1362 (9.7%) and 111\/1776 (6.2%), respectively, for epochs 1 and 2). More than 90% of infants died after withdrawal of life\u2010sustaining treatment, an increase from the previous two epochs (75%). There was a reduction in deaths from chromosomal abnormalities, complications related to prematurity and severe birth asphyxia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There continue to be changes in both the diagnoses leading to death and approaches to withdrawal of treatment in the NICU. These may reflect ongoing changes in both prenatal and post\u2010natal diagnostics as well as changing attitudes towards palliative care within the medical and wider community.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jpc.16296","type":"journal-article","created":{"date-parts":[[2022,12,10]],"date-time":"2022-12-10T13:11:00Z","timestamp":1670677860000},"page":"341-345","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["End\u2010of\u2010life care over four decades in a quaternary neonatal intensive care unit"],"prefix":"10.1111","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3547-1526","authenticated-orcid":false,"given":"Alexandra","family":"Barry","sequence":"first","affiliation":[{"name":"Neonatal Medicine Royal Children's Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4271-7950","authenticated-orcid":false,"given":"Trisha","family":"Prentice","sequence":"additional","affiliation":[{"name":"Neonatal Medicine Royal Children's Hospital  Melbourne Victoria Australia"},{"name":"Murdoch Children's Research Institute  Melbourne Victoria Australia"},{"name":"Department of Paediatrics University of Melbourne  Melbourne Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3958-8633","authenticated-orcid":false,"given":"Dominic","family":"Wilkinson","sequence":"additional","affiliation":[{"name":"Murdoch Children's Research Institute  Melbourne Victoria Australia"},{"name":"Oxford Uehiro Centre for Practical Ethics, Faculty of Philosophy University of Oxford  Oxford United Kingdom"},{"name":"Newborn Care John Radcliffe Hospital  Oxford United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12,10]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2012.02425.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2017.02.006"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2019.0523"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197310252891705"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.1994.tb00692.x"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004-0447"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PCC.0000128893.23327.C1"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2003.032912"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2005-0392"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1159\/000153100"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/children5020021"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269216316634246"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2018-001538"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2014.189"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2014.193"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2005.074971"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/1477750915622033"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/15265161.2010.540060"},{"key":"e_1_2_7_20_1","unstructured":"National Statement on Ethical Conduct in Human Research 2007. 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