• A A Eduard Verhagen, Jozef H H M Dorscheidt, Bernadette Engels, Joep H Hubben, and Pieter J Sauer.
• Department of Pediatrics, University Medical Centre, 9700 RB Groningen, the Netherlands. e.verhagen@bkk.umcg.nl
• Arch Pediatr Adolesc Med. 2009 Oct 1;163(10):895-901.

ObjectiveTo clarify the practice of end-of-life decision making in severely ill newborns.DesignRetrospective descriptive study with face-to-face interviews.SettingThe 10 neonatal intensive care units in the Netherlands from October 2005 to September 2006.PatientsAll 367 newborn infants who died in the first 2 months of life in Dutch neonatal intensive care units. Adequate documentation was available in 359 deaths.Outcome MeasuresPresence of end-of-life decisions, classification of deaths in 3 groups, and physicians' considerations leading to end-of-life decisions.ResultsAn end-of-life decision preceded death in 95% of cases, and in 5% treatment was continued until death. Of all of the deaths, 58% were classified as having no chance of survival and 42% were stabilized newborns with poor prognoses. Withdrawal of life-sustaining therapy was the main mode of death in both groups. One case of deliberate ending of life was found. In 92% of newborns with poor prognoses, end-of-life decisions were based on patients' future quality of life and mainly concerned future suffering. Considerations regarding the infant's present state were made in 44% of infants.ConclusionsVirtually all deaths in Dutch neonatal intensive care units are preceded by the decision to withdraw life-sustaining treatment and many decisions are based on future quality of life. The decision to deliberately end the life of a newborn may occur less frequently than was previously assumed.

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