Characteristics of babies who unexpectedly survive long-term.after withdrawal of intensive care.

Occasional babies survive long-term after withdrawal of intensive care despite a poor prognosis. We aimed to review in detail the clinical cases, characteristics, and outcomes of neonates with unexpected protracted survival following planned withdrawal of intensive cardiorespiratory support.We reviewed infants who unexpectedly survived for more than 1 week following planned withdrawal of intensive care in two tertiary-level NICUs over a 7-year period.We identified 8 long-term survivors (6 term, 2 preterm) between 2007-2013. All had a clinical diagnosis of grade 3 hypoxic-ischaemic encephalopathy and severely abnormal electroencephalography and neuroimaging prior to intensive care withdrawal. Intensive care was withdrawn at 5 days postnatal age (range: 2-9 days), but the possibility of protracted survival was discussed beforehand in only two cases. Three infants died before 3 months of age. Five infants remain alive, currently aged from 2.0-6.5 years, and all have significant neurodevelopmental problems.Unexpected long-term survival after neonatal intensive care withdrawal occurs occasionally but unpredictably. Significant neurodevelopmental adversity was invariable in those surviving beyond infancy. Ventilator dependency along with severely abnormal electroencephalography and neuroimaging is still compatible with long-term survival. The possibility of protracted survival should be discussed routinely with parents before intensive care withdrawal. This article is protected by copyright. All rights reserved.