Life and death decisions in the extremely preterm infant: What happens in a level III perinatal centre?
Bibliographic record
Abstract
To describe resuscitation decisions and withdrawal of treatment practices in live-born infants at the extremes of prematurity at St Joseph's Health Care (London, Ontario). A retrospective chart review was conducted on all neonatal deaths between 22 weeks, zero days' and 25 weeks, six days' gestational age over an eight-year period. Documentation concerning end-of-life discussions was subjected to thematic review to limit or withhold resuscitation or withdraw treatment. Three hundred eighteen infants were delivered between 22 weeks, zero days' and 25 weeks, six days' gestational age. Of these, 21% of infants (67 of 318) were stillborn, 38% (121 of 318) were alive on discharge from hospital and 41% (130 of 318) died in the neonatal period. Of the live-born infants who did not survive to discharge, 34% (44 of 130) had no initial attempts at resuscitation. Withdrawal of life-sustaining treatment was the immediate cause of death in 84% of cases (61 of 73) in which the infant survived initial resuscitation. Documented parental rationale for withdrawal of treatment included “preventing pain and suffering”, “not wanting (their baby) to die on a ventilator” and “poor quality of life”. Families in which the mother identified as Catholic were more likely to withhold resuscitation and to withdraw life-sustaining treatment because death was imminent despite ongoing treatment. Non-Catholic families were more likely to withdraw life-sustaining treatment based on prediction of a poor long-term prognosis. Decisions not to initiate resuscitation remain fairly common practice at the extremes of prematurity. The majority of deaths in those who survive initial resuscitative measures are secondary to withdrawal of treatment decisions made in the neonatal intensive care unit. Décrire les pratiques en matière de décision de réanimation et de suspension du traitement chez les nourrissons nés vivants aux extrêmes de la prématurité au St Joseph's Health Care de London, en Ontario. Les auteurs ont procédé à une analyse rétrospective des dossiers pour colliger tous les décès néonatals entre 22 semaines et zéro jour et 25 semaines et six jours de grossesse sur une période de huit ans. La documentation portant sur les discussions de fin de vie a fait l'objet d'une analyse thématique afin de limiter ou de ne pas amorcer la réanimation ou de suspendre le traitement. Trois cent dix-huit nourrissons sont nés entre 22 semaines et zéro jour et 25 semaines et six jours de grossesse. De ce nombre, 21 % (67 sur 318) étaient mortnés, 38 % (121 sur 318) étaient vivants à leur congé de l'hôpital et 41 % (130 sur 318) étaient morts pendant la période néonatale. Parmi les nourrissons nés vivants qui n'ont pas survécu jusqu'au congé, 34 % (44 sur 130) n'avaient pas reçu les étapes initiales de réanimation. La suspension d'un traitement de survie était la cause immédiate de décès dans 84 % des cas (61 sur 73) où le nourrisson avait survécu aux étapes initiales de la réanimation. Les raisons documentées invoquées par les parents pour suspendre le traitement étaient : « prévenir la douleur et la souffrance », « ne pas vouloir (que leur bébé) meure sous ventilation » et « une mauvaise qualité de vie ». Les familles dont la mère se disait catholique étaient plus susceptibles de ne pas amorcer la réanimation et de suspendre un traitement de survie parce que le décès était imminent malgré un traitement continu. Les familles non catholiques étaient plus susceptibles de suspendre un traitement de survie en raison de l'éventualité d'un mauvais pronostic à long terme. Les décisions de ne pas amorcer la réanimation demeurent relativement courantes aux extrêmes de la prématurité. La majorité des décès chez les nourrissons qui survivent aux étapes initiales de la réanimation découlent d'une décision de suspendre le traitement prise à l'unité de soins intensifs néonatals.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".