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The Continuing Importance of How Neonates Die

A. A. Eduard Verhagen, MD, PhD, JD1; Annie Janvier, MD, PhD2
[+] Author Affiliations
1University Medical Center Groningen, Department of Pediatrics, University of Groningen, Groningen, the Netherlands
2University of Montreal Division of Neonatology and Clinical Ethics, Sainte-Justine Hospital, Montreal, Quebec, Canada
JAMA Pediatr. 2013;167(11):987-988. doi:10.1001/jamapediatrics.2013.3065.
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More than a century ago, the leaders of public health identified the infant mortality rate as a key measure to assess and understand the health of society.1 Today, the infant mortality rate of a country or region remains an important marker of public health in many parts of the world for the reasons articulated 100 years ago. In countries with advanced health care systems, however, the infant mortality rate of groups of infants has assumed a new set of roles that can only be properly performed if we pay close attention to the manner in which newborns in these countries die.



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The Continuing Change of Medical Care
Posted on September 16, 2013
Floris Groenendaal
University Medical Center Utrecht, Utrecht, the Netherlands
Conflict of Interest: None Declared
Dear Sir,Verhagen and Janvier have described medical care processes involved in care of neonates who died.‘In the developed world, gone are the days when infants simply died’, they state. Although their paper is highly relevant, I would like to comment on one aspect of this paper.It is important to note, that in the Netherlands views on care of extremely preterm neonates has developed as well. Since September 2010 obstetricians and neonatologists agreed nationwide in actively resuscitating neonates from a gestational age of 24.0 weeks onwards. Since then, mortality in neonates with a gestational age from 24+0 to 24+6 weeks ranges between 45 and 50%, which is well in the range of other countries actively resuscitating neonates with such a low gestational age. Data on long-term morbidity are yet unknown, but will be collected[1].In addition, data on perinatal deaths are collected to provide insight into the relevant ethical aspects of medical care at the limits of viability raised by Verhagen and Janvier.Floris Groenendaal, MD PhDAssociate Professor of Neonatology and Clinical EpidemiologistWilhelmina Children’s HospitalUniversity Medical Center UtrechtUtrecht,The NetherlandsReference 1. Groenendaal F, Uiterwaal C: Long term follow-up of extremely preterm neonates. BMJ 2012;345:e8252.
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