[Limitations to care; evaluation of decision making concerning the death of 104 children in a surgical intensive care unit].

Objective: To analyse the decision-making process concerning withholding and withdrawal of life-sustaining treatment in children who died in a paediatric surgical intensive care unit.

Design: Retrospective evaluation of medical and nursing records from the period 1988-1992.

Setting: Sophia Children's Hospital-University Hospital Rotterdam.

Method: The evaluation concerned 104 children who died in the paediatric surgical intensive care unit during the study period. The causes of death were classified according to the classification proposed in a recent report issued by the Dutch Association of Paediatricians. A distinction was made between newborns and older children.

Results: In both newborns and older children, about half of the children had died because treatment was either withheld (4/104) or withdrawn (53/104). There were no cases of 'intentional termination of life in emergencies'. The remaining children had died in spite of medical treatment that had been considered worthwhile.

Conclusion: The problems and guidelines suggested from the field of neonatology are applicable not only to newborns with severe congenital anomalies, but also to older children. Evaluation of the decision-making process should not be limited to medical-technical and nursing aspects, but should also include the experiences of the parents and the treatment team.