Journal Mobile Options
Table of Contents
Vol. 95, No. 2, 2009
Issue release date: February 2009
Neonatology 2009;95:157–163

Causes and Circumstances of Neonatal Deaths in 108 Consecutive Cases over a 10-Year Period at the Children’s Hospital of Lucerne, Switzerland

Berger T.M. · Hofer A.
Neonatal and Pediatric Intensive Care Unit, Children’s Hospital of Lucerne, Lucerne, Switzerland

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


Background: Neonatal deaths still represent the largest percentage of overall childhood mortality. Many deaths of neonates are preceded by end-of-life decisions; however, decision-making practices have been reported to vary widely from country to country. Objectives: To analyze principal causes and circumstances of all consecutive neonatal deaths at our institution over a 10-year period. Methods: All neonates who had died either in the delivery room (DR) or the neonatal intensive care unit (NICU) between January 1, 1997 and December 31, 2006 were identified. Demographic information, principal causes and circumstances of death were abstracted from the individual medical records. Results: There were approximately 72,000 live births in the catchment area of our center with 15,150 deliveries occurring at the Women’s Hospital of Lucerne. Of the 108 deaths identified, 29 occurred in the DR (DR mortality rate 0.2%) and 79 in the NICU (NICU mortality rate 2.3%). The majority of DR deaths occurred in the setting of primary nonintervention and were related to extreme prematurity (n = 20), lethal congenital malformations (n = 6) and trisomy 13 (n = 2). One patient with severe perinatal asphyxia died despite full resuscitative efforts. In the NICU, overall mortality rate was inversely related to gestational age (GA). Cardiovascular and respiratory system failures were the predominant causes of death in premature infants with a GA <32 weeks, whereas CNS catastrophes accounted for the majority of deaths in the more mature NICU population. End-of-life decisions were common with less than 10% of deaths occurring despite maximal intensive care. Conclusions: In our perinatal center, primary nonintervention and redirection of care are the most common circumstances of death in neonates. This reflects our belief that, apart from futility, quality-of-life considerations are an important part of decision making in neonatology.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  1. Minino AM, Heron MP, Murphy SL, Kochanek KD: Deaths: final data for 2004. Natl Vital Stat Rep 2007;55:1–119.

    External Resources

  2. Wall SN, Partridge JC: Death in the intensive care nursery: physician practice of withdrawing and withholding life support. Pediatrics 1997;99:64–70.
  3. Cook LA, Watchko JF: Decision making for the critically ill neonate near the end of life. J Perinatol 1996;16:133–136.
  4. Duff RS, Campbell AG: Moral and ethical dilemmas in the special-care nursery. N Engl J Med 1973;289:890–894.
  5. Barton L, Hodgman JE: The contribution of withholding or withdrawing care to newborn mortality. Pediatrics 2005;116:1487–1491.
  6. Hagen CM, Hansen TW: Deaths in a neonatal intensive care unit: a 10-year perspective. Pediatr Crit Care Med 2004;5:463–468.
  7. Cuttini M, Nadai M, Kaminski M, Hansen G, de Leeuw R, Lenoir S, Persson J, Rebagliato M, Reid M, de Vonderweid U, Lenard HG, Orzalesi M, Saracci R: End-of-life decisions in neonatal intensive care: physicians’ self-reported practices in seven European countries. EURONIC Study Group. Lancet 2000;355:2112–2118.
  8. De Leeuw R, de Beaufort AJ, de Kleine MJ, van Harrewijn K, Kollée LA: Foregoing intensive care treatment in newborn infants with extremely poor prognoses. A study in four neonatal intensive care units in The Netherlands. J Pediatr 1996;129:661–666.
  9. De Leeuw R, Cuttini M, Nadai M, Berbik I, Hansen G, Kucinskas A, Lenoir S, Levin A, Persson J, Rebagliato M, Reid M, Schroell M, de Vonderweid U: Treatment choices for extremely preterm infants: an international perspective. J Pediatr 2000;137:608–616.
  10. Schulz-Baldes A, Huseman D, Loui A, Dudenhausen JW, Obladen M: Neonatal end-of-life practice in a German perinatal centre. Acta Paediatr 2007;96:681–687.
  11. Arlettaz R, Mieth D, Bucher HU, Duc G, Fauchere JC: End-of-life decisions in delivery room and neonatal intensive care unit. Acta Paediatr 2005;94:1626–1631.
  12. Berner ME, Rimensberger PC, Huppi PS, Pfister RE: National ethical directives and practical aspects of forgoing life-sustaining treatment in newborn infants in a Swiss intensive care unit. Swiss Med Wkly 2006;136:597–602.
  13. Baumann-Holzle R, Maffezzoni M, Bucher HU: A framework for ethical decision making in neonatal intensive care. Acta Paediatr 2005;94:1777–1783.
  14. Swiss Society of Neonatology: Recommendations for the care of infants born at the limit of viability (gestational age 22–26 weeks). Paediatrica 2002;13:27–33.
  15. Swiss Academy for Medical Sciences: URL:
  16. Singh J, Fanaroff J, Andrews B, Caldarelli L, Lagatta J, Plesha-Troyke S, Lantos J, Meadow W: Resuscitation in the ‘gray zone’ of viability: determining physician preferences and predicting infant outcomes. Pediatrics 2007;120:519–526.
  17. Saugstad OD: When newborn infants are bound to die. Acta Paediatr 2005;94:1535–1537.
  18. Singh J, Lantos J, Meadow W: End-of-life after birth: death and dying in a neonatal intensive care unit. Pediatrics 2004;114:1620–1626.
  19. Hentschel R, Lindner K, Krueger M, Reiter-Theil S: Restriction of ongoing intensive care in neonates: a prospective study. Pediatrics 2006;118:563–569.
  20. Meadow W, Frain L, Ren Y, Lee G, Soneji S, Lantos J: Serial assessment of mortality in the neonatal intensive care unit by algorithm and intuition: certainty, uncertainty, and informed consent. Pediatrics 2002;109:878–886.
  21. Orzalesi M, Cuttini M: Ethical considerations in neonatal respiratory care. Biol Neonate 2005;87:345–353.
  22. Leuthner SR: Decisions regarding resuscitation of the extremely premature infant and models of best interest. J Perinatol 2001;21:193–198.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50