• C A Fajardo, S González, G Zambosco, M J Cancela, L V Forero, M Venegas, H Baquero, L Lemus-Varela, J Kattan, F Wormald, A Sola, and J Lantos.
• University of Calgary, Alberta, Canada. carlos.fajardo@albertahealthservices.ca
• Acta Paediatr. 2012 Jun 1; 101 (6): 609-13.

AimMost analyses of end of life decisions in Neonatal Intensive Care Units (NICUs) have come from Europe/English-speaking countries. Would decisions be different in Latin American NICUs? Therefore, we aim to evaluate the approach to dying infants/families in NICUs in Latin America.MethodsMultinational descriptive study of all deaths in babies born at >22 weeks in eight NICUs in five Latin American countries. Deaths were categorized as: (i) no Cardiopulmonary Resuscitation (CPR) or life support offered; (ii) life support initiated but do not resuscitate (DNR) orders written or no CPR provided; (iii) full life support and CPR; and (iv) unclassifiable.ResultsThere were 100 deaths, 81% in >27 weeks. Seventeen infants received no CPR/life support at birth, 10 died in DR and seven in NICU. There were 27 infants in group 2, 54 in group three and two in group 4. No baby had care withdrawn or care withdrawn/CPR withheld. Thirty-two infants had 'do not resuscitate' order. Decisions without parents' involvement in 15%, both parents present at death 24% and sedatives/narcotics documented 14%.ConclusionsLatin American NICUs differ from those in Northern Europe/English-speaking countries. More deaths are accompanied by full life support and CPR. DNR orders are rare. Withdrawal of life support is virtually non-existent. Latin American's doctors are more likely to make decisions without the objections of family about withholding life-sustaining treatment.© 2012 The Author(s)/Acta Paediatrica © 2012 Foundation Acta Paediatrica.

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