Am J Perinatol 2024; 41(06): 700-705
DOI: 10.1055/a-1712-5313
Original Article

Trends in length of stay for Neonatal Intensive Care Unit patients who die before hospital discharge

1   Division of Newborn Medicine, Department of Pediatrics, the Icahn School of Medicine at Mount Sinai, New York
Nicholas Puoplo
2   Department of Pediatrics, the Icahn School of Medicine at Mount Sinai, New York
Felix Richter
3   Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York
Andrea S. Weintraub
1   Division of Newborn Medicine, Department of Pediatrics, the Icahn School of Medicine at Mount Sinai, New York
› Author Affiliations
Funding None.


Objective The objectives of this study were to establish days between birth and death for neonates over a 14-year period, determine if days between birth and death have changed over time across gestational age cohorts, and identify diagnoses which may put infants at high risk of prolonged hospitalization leading to death.

Study Design This was a single-site, retrospective chart review of inborn infants who died prior to hospital discharge.

Results Two hundred and thirty-nine patients born between 1/1/2006 and 12/31/2020 met inclusion criteria. Days until death ranged from 0 to 300 with a median of 6 days (interquartile range = 23). Median days until death increased over time, with a statistically significant increase between epoch 1 and epoch 2 (p = 0.016) but not between epoch 2 and epoch 3 (p = 0.618). Extremely premature infants died earlier than more mature infants (p < 0.001). In addition, infants with complex congenital heart disease or a gastrointestinal (GI) catastrophe died later (p < 0.001 and p < 0.001, respectively) than newborns without cardiac or GI issues.

Conclusion Our findings demonstrate an increase in time to death for newborns who did not survive to hospital discharge over a 14-year period. This trend suggests that the dynamics informing Meadows' assertion that “doomed infants die early” may be shifting, with some seriously ill infants who die before hospital discharge surviving longer than previously described. More research is needed to understand how best to care for babies who will not survive to discharge and to explore when supports such as palliative care consultation may be beneficial.

Key Points

As per W. Meadow, “Doomed infants die early”

  • Pre-death length of stay varies with diagnosis.

  • Some seriously ill infants who die before hospital discharge are no longer dying early.

  • These infants and families may need supports.

Publication History

Received: 07 July 2021

Accepted: 01 December 2021

Accepted Manuscript online:
03 December 2021

Article published online:
31 December 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Meadow W. Epidemiology, economics, and ethics in the NICU: reflections from 30 years of neonatology practice. J Pediatr Gastroenterol Nutr 2007; 45 (Suppl. 03) S215-S217
  • 2 Lantos JD, Meadow WL. Costs and end-of-life care in the NICU: lessons for the MICU?. J Law Med Ethics 2011; 39 (02) 194-200
  • 3 Lantos JD. Ethical problems in decision making in the neonatal ICU. N Engl J Med 2018; 379 (19) 1851-1860
  • 4 Prentice T, Janvier A, Gillam L, Davis PG. Moral distress within neonatal and paediatric intensive care units: a systematic review. Arch Dis Child 2016; 101 (08) 701-708
  • 5 Rosenthal SA, Nolan MT. A meta-ethnography and theory of parental ethical decision making in the neonatal intensive care unit. J Obstet Gynecol Neonatal Nurs 2013; 42 (04) 492-502
  • 6 Discenza D. “Mental Health” in the NICU: time to catch up and provide trauma-informed care for families and pros. Neonatal Netw 2017; 36 (05) 318-320
  • 7 Humphrey L, Schlegel A, Seabrook R, McClead R. Trigger criteria to increase appropriate palliative care consultation in the neonatal intensive care unit. Pediatr Qual Saf 2019; 4 (01) e129
  • 8 Younge N, Goldstein RF, Bann CM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Survival and neurodevelopmental outcomes among periviable infants. N Engl J Med 2017; 376 (07) 617-628
  • 9 Soll RF, Edwards EM, Badger GJ. et al. Obstetric and neonatal care practices for infants 501 to 1500 g from 2000 to 2009. Pediatrics 2013; 132 (02) 222-228
  • 10 Jacob J, Kamitsuka M, Clark RH, Kelleher AS, Spitzer AR. Etiologies of NICU deaths. Pediatrics 2015; 135 (01) e59-e65
  • 11 Wilkinson DJ, Fitzsimons JJ, Dargaville PA. et al. Death in the neonatal intensive care unit: changing patterns of end of life care over two decades. Arch Dis Child Fetal Neonatal Ed 2006; 91 (04) F268-F271
  • 12 Simpson CDA, Ye XY, Hellmann J, Tomlinson C. Trends in cause-specific mortality at a Canadian outborn NICU. Pediatrics 2010; 126 (06) e1538-e1544
  • 13 Michel MC, Colaizy TT, Klein JM, Segar JL, Bell EF. Causes and circumstances of death in a neonatal unit over 20 years. Pediatr Res 2018; 83 (04) 829-833
  • 14 Harrison W, Goodman D. Epidemiologic trends in neonatal intensive care, 2007–2012. JAMA Pediatr 2015; 169 (09) 855-862
  • 15 Dorfman AT, Marino BS, Wernovsky G. et al. Critical heart disease in the neonate: presentation and outcome at a tertiary care center. Pediatr Crit Care Med 2008; 9 (02) 193-202
  • 16 Bertaud S, Lloyd DFA, Laddie J, Razavi R. The importance of early involvement of paediatric palliative care for patients with severe congenital heart disease. Arch Dis Child 2016; 101 (10) 984-987
  • 17 May R, Thompson J. The role of pediatric palliative care in complex congenital heart disease: three illustrative cases. J Palliat Med 2017; 20 (11) 1300-1303
  • 18 Samuels N, van de Graaf RA, de Jonge RCJ, Reiss IKM, Vermeulen MJ. Risk factors for necrotizing enterocolitis in neonates: a systematic review of prognostic studies. BMC Pediatr 2017; 17 (01) 105
  • 19 Linton JM, Feudtner C. What accounts for differences or disparities in pediatric palliative and end-of-life care? A systematic review focusing on possible multilevel mechanisms. Pediatrics 2008; 122 (03) 574-582
  • 20 Rempel GR. Technological advances in pediatrics: challenges for parents and nurses. J Pediatr Nurs 2004; 19 (01) 13-24