Abstract
Objective The objectives of this study were to establish days between birth and death for neonates
over a 14-year period, determine if days between birth and death have changed over
time across gestational age cohorts, and identify diagnoses which may put infants
at high risk of prolonged hospitalization leading to death.
Study Design This was a single-site, retrospective chart review of inborn infants who died prior
to hospital discharge.
Results Two hundred and thirty-nine patients born between 1/1/2006 and 12/31/2020 met inclusion
criteria. Days until death ranged from 0 to 300 with a median of 6 days (interquartile
range = 23). Median days until death increased over time, with a statistically significant
increase between epoch 1 and epoch 2 (p = 0.016) but not between epoch 2 and epoch 3 (p = 0.618). Extremely premature infants died earlier than more mature infants (p < 0.001). In addition, infants with complex congenital heart disease or a gastrointestinal
(GI) catastrophe died later (p < 0.001 and p < 0.001, respectively) than newborns without cardiac or GI issues.
Conclusion Our findings demonstrate an increase in time to death for newborns who did not survive
to hospital discharge over a 14-year period. This trend suggests that the dynamics
informing Meadows' assertion that “doomed infants die early” may be shifting, with
some seriously ill infants who die before hospital discharge surviving longer than
previously described. More research is needed to understand how best to care for babies
who will not survive to discharge and to explore when supports such as palliative
care consultation may be beneficial.
Key Points
As per W. Meadow, “Doomed infants die early”
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Pre-death length of stay varies with diagnosis.
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Some seriously ill infants who die before hospital discharge are no longer dying early.
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These infants and families may need supports.
Keywords
neonate - death - ethics - palliative care
