Étude rétrospective descriptive des pratiques de limitation et arrêt des traitements chez les extrêmes prématurés au CHU de Bordeaux sur une période de sept ans

Abstract : Introduction: according to the national population-based cohort study EPIPAGE 2, 81% of the deaths of infants born before 24 weeks’ gestation and 70% at 25 through 26 weeks were following a decision to withholding or withdrawal of life sustaining treatment (LST) with no more details about these procedures. Our aim was to describe the population of extremely preterm infants and decision making process to withholding or withdrawal of LST in the University Hospital of Bordeaux. Material and Method: we carried out a retrospective observational study from January 1, 2011 to September 30, 2017at the University Hospital of Bordeaux. Neonates born between 22 and 26 completed weeks’ gestation were included. Data about pregnancy, birth conditions, infant survival, severe neonatal morbidity and decision to limit LST were collected. Results: the study included 451 neonates. There was no survivor born at 22 through 23 weeks. The proportion of deaths following a decision to limit LST was 68%. Our study described 79 decisions to withholding or withdrawal of LST concerning 63 neonates. Nineteen procedures were considered as emergency procedures. The annual number of decisions to limit LST slighlty increased over the years. Collegiality was fulfilled in all situations where we had complete data, excluding emergency procedures. Parents approved the end-of-life project in all cases. The percentage of missing data decreased over the years to reach 4% in 2017. Conclusion: palliative care are well established in neonatology. Traceability, parents’ agreement and collegiality are three objectives achieved in our study. In the future, we purpose to organize multidisciplinary meetings for all extremely preterm infants, in their first week of life. Formalized specific documents « withholding or withdrawal of LST in Neonate » and in emergency situation are proposed at the end of this work.
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Master Thesis
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Sandra Jalvy-Delvaille. Étude rétrospective descriptive des pratiques de limitation et arrêt des traitements chez les extrêmes prématurés au CHU de Bordeaux sur une période de sept ans. Médecine humaine et pathologie. 2018. ⟨dumas-02068321⟩

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