Utility of do-not-resuscitate orders for critically ill infants in the NICU

Utility of do-not-resuscitate orders for critically ill infants in the NICU 
Pediatric Research - the American Pediatric Society, the European Society for Paediatric Research, and the Society for Pediatric Research; by Shannon Y. Adams, Katherine Redford, Randall Li, Ana Malfa, Richard Tucker and Beatrice E. Lechner; 7/5/24 
To better understand the value of DNR orders for critically ill infants in the NICU, a prospective mixed-methods approach was utilized including chart review of infants who died in a regional NICU over a twenty-six-month period and surveys of their neonatologists, neonatal fellows, and nurses. Impact:

• In the adult and pediatric ICU literature, DNR orders are associated with improved qualitative “good death” assessments and decreased familial decision regret. In the NICU, rates of DNR usage aren’t well reported and their overall utility is unclear.
• Though DNR orders can help guide clinical decision making in the NICU and may be associated with higher quality ethical discussion, our data suggest that they are not applicable in all patient cases.
• We hope that this work will help guide approaches to end-of-life care in the NICU and underscore the importance of frequent, open communication between families and their medical team.