Causes and Circumstances of Death in a Neonatal Unit over 20 Years

BACKGROUND: We examined changes in the causes and circumstances of death in our NICU over 20 years. METHODS: For 551 infants who died between 1993 and 2013, the principal cause of death was recorded. Circumstances of death were assigned to one of 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. RESULTS: The 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%). CONCLUSIONS: The mortality rate per admission decreased between 1993 and 2013. All causes of death were 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.