Short-term outcomes of treatment limitation discussions in neonatal care units of tertiary care hospital in Karachi, Pakistan: a cross-sectional study
Objective To determine the short-term outcomes of treatment limitation discussions (TLDs) in neonates with life-limiting conditions and life-threatening conditions.Design Descriptive cross-sectional study.Settings The study was conducted at the neonatal care units of a single tertiary care hospital...
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BMJ Publishing Group
2025-05-01
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| Series: | BMJ Paediatrics Open |
| Online Access: | https://bmjpaedsopen.bmj.com/content/9/1/e003154.full |
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| author | Aneela Pasha Rozina Iqbal Ariba Siddiqui Wajiha Khan Danish Abdul Aziz Arshalooz Rahman |
| author_facet | Aneela Pasha Rozina Iqbal Ariba Siddiqui Wajiha Khan Danish Abdul Aziz Arshalooz Rahman |
| author_sort | Aneela Pasha |
| collection | DOAJ |
| description | Objective To determine the short-term outcomes of treatment limitation discussions (TLDs) in neonates with life-limiting conditions and life-threatening conditions.Design Descriptive cross-sectional study.Settings The study was conducted at the neonatal care units of a single tertiary care hospital in Karachi, Pakistan.Patients Neonates for whom clinicians or parents considered TLDs were included in the study. The study duration was from May 2022 to May 2023.Interventions None.Main outcome measures Primary outcome was documented in the form of frequency of full code, withdrawal of life-sustaining support, and do not resuscitate (DNR) orders in neonates. The secondary outcome was categorised as discharge, death, transfer from the neonatal intensive care unit (NICU) to a step-down unit or leave against medical advice (LAMA).Results A total of 115 patients were included. Full code was documented in 14 patients (12.2%), withdrawal of life-sustaining support in 54 cases (47.0%) and DNR in 47 patients (40.9%). Of the 115 cases, 11 (9.6%) were discharged, 90 (78.3%) died, 7 (6.1%) were shifted out of the NICU and 7 (6.1%) LAMA. We found that 14 out of 115 parents (12.2%) chose the full code option despite clinicians advising withdrawal or DNR. Of those, 13 (92.8%) did not survive, and 1 (7.1%) was shifted out of the NICU.Conclusions The most frequent outcome after TLD was withdrawal of life-sustaining support. The majority of babies did not survive following TLD, irrespective of the code decided. Early transition out of the NICU was considered for babies with DNR orders. |
| format | Article |
| id | doaj-art-aa81363921084eae81ffe8f65e668eef |
| institution | OA Journals |
| issn | 2399-9772 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Paediatrics Open |
| spelling | doaj-art-aa81363921084eae81ffe8f65e668eef2025-08-20T02:29:09ZengBMJ Publishing GroupBMJ Paediatrics Open2399-97722025-05-019110.1136/bmjpo-2024-003154Short-term outcomes of treatment limitation discussions in neonatal care units of tertiary care hospital in Karachi, Pakistan: a cross-sectional studyAneela Pasha0Rozina Iqbal1Ariba Siddiqui2Wajiha Khan3Danish Abdul Aziz4Arshalooz Rahman52Department of Community Health Sciences, Aga Khan University Karachi PAKISTANPaediatrics and Child Health, The Aga Khan University Hospital, Karachi, PakistanPaediatrics and Child Health, The Aga Khan University Hospital, Karachi, PakistanPaediatrics and Child Health, The Aga Khan University Hospital, Karachi, PakistanPaediatrics and Child Health, The Aga Khan University Hospital, Karachi, PakistanPaediatrics and Child Health, The Aga Khan University Hospital, Karachi, PakistanObjective To determine the short-term outcomes of treatment limitation discussions (TLDs) in neonates with life-limiting conditions and life-threatening conditions.Design Descriptive cross-sectional study.Settings The study was conducted at the neonatal care units of a single tertiary care hospital in Karachi, Pakistan.Patients Neonates for whom clinicians or parents considered TLDs were included in the study. The study duration was from May 2022 to May 2023.Interventions None.Main outcome measures Primary outcome was documented in the form of frequency of full code, withdrawal of life-sustaining support, and do not resuscitate (DNR) orders in neonates. The secondary outcome was categorised as discharge, death, transfer from the neonatal intensive care unit (NICU) to a step-down unit or leave against medical advice (LAMA).Results A total of 115 patients were included. Full code was documented in 14 patients (12.2%), withdrawal of life-sustaining support in 54 cases (47.0%) and DNR in 47 patients (40.9%). Of the 115 cases, 11 (9.6%) were discharged, 90 (78.3%) died, 7 (6.1%) were shifted out of the NICU and 7 (6.1%) LAMA. We found that 14 out of 115 parents (12.2%) chose the full code option despite clinicians advising withdrawal or DNR. Of those, 13 (92.8%) did not survive, and 1 (7.1%) was shifted out of the NICU.Conclusions The most frequent outcome after TLD was withdrawal of life-sustaining support. The majority of babies did not survive following TLD, irrespective of the code decided. Early transition out of the NICU was considered for babies with DNR orders.https://bmjpaedsopen.bmj.com/content/9/1/e003154.full |
| spellingShingle | Aneela Pasha Rozina Iqbal Ariba Siddiqui Wajiha Khan Danish Abdul Aziz Arshalooz Rahman Short-term outcomes of treatment limitation discussions in neonatal care units of tertiary care hospital in Karachi, Pakistan: a cross-sectional study BMJ Paediatrics Open |
| title | Short-term outcomes of treatment limitation discussions in neonatal care units of tertiary care hospital in Karachi, Pakistan: a cross-sectional study |
| title_full | Short-term outcomes of treatment limitation discussions in neonatal care units of tertiary care hospital in Karachi, Pakistan: a cross-sectional study |
| title_fullStr | Short-term outcomes of treatment limitation discussions in neonatal care units of tertiary care hospital in Karachi, Pakistan: a cross-sectional study |
| title_full_unstemmed | Short-term outcomes of treatment limitation discussions in neonatal care units of tertiary care hospital in Karachi, Pakistan: a cross-sectional study |
| title_short | Short-term outcomes of treatment limitation discussions in neonatal care units of tertiary care hospital in Karachi, Pakistan: a cross-sectional study |
| title_sort | short term outcomes of treatment limitation discussions in neonatal care units of tertiary care hospital in karachi pakistan a cross sectional study |
| url | https://bmjpaedsopen.bmj.com/content/9/1/e003154.full |
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