End of life neonatal care: withdrawal of artificial nutrition and hydration

Withdrawal of artificial nutrition and hydration is sometimes considered in infants with severe neurological impairment who survive despite withdrawal of invasive life-sustaining treatment. A paper from Canada reviews 15 cases where artificial nutrition and hydration was withdrawn (because of severe neurological injury mainly from hypoxic–ischaemic encephalopathy and poor prognosis), representing 0.5% of admissions and 5.5% of all deaths.[1] The median time to death after withdrawal was 16 days (range 2–37 days). The parents of 10 infants participated in a survey 1–4 years after the infant's death. Parents generally felt well supported. The main concern (expressed by seven parents) was whether their infant was in pain, and parents also recommended improved consistency and continuity of care.

Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au