Causes and circumstances of death in a neonatal unit over 20 years.

BackgroundWe examined changes in the causes and circumstances of death in our neonatal intensive care unit (NICU) over 20 years.MethodsFor 551 infants who died between 1993 and 2013, the principal cause of death was recorded. Circumstances of death were assigned to one of the following four categories: death following cardiopulmonary resuscitation (CPR), death while being mechanically ventilated without CPR, death after withholding life-support interventions, and death after withdrawal of life support. Data were compared across four 5-year epochs.ResultsThe mortality rate decreased from 5.9% in the first epoch to 3.0% in the last epoch (P<0.0001). The leading cause of death in all epochs was congenital anomalies. The percentage of deaths due to all other categories decreased or remained stable. Withdrawal of life support was the most common circumstance of death in all four epochs. Only 16% of deaths followed CPR. The percentage of neonates with documented do-not-resuscitate orders was highest in the final cohort (52%).ConclusionsThe mortality rate per admission decreased between 1993 and 2013. Each cause of death was stable or decreased as a percentage of all deaths except for deaths due to congenital anomalies. Withdrawal of life-support interventions is the most common circumstance of death in neonates.