Objective To analyze circumstances of all consecutive neonatal deaths by HIE over a 10 year period and examine changes along timeSetting. Level III Neonatal Intensive Care. Madrid, Spain.

Design Retrospective chart review of all neonatal cases with HIE who died from 2000 to 2010 within the neonatal period.

Results Of a total 70 infants with HIE, 18 died during the neonatal period. All of them had severe HIE and the mean age of death was 64.4±51 hours of life. In 17 (94%) the death was preceded by an end-of-life decision based on the bad prognosis; 15 by withdrawal or limitation of therapy (W/LT) while ventilated, and 2 by decision of parents not to resuscitate if cardiac arrest. All patients had coma and at least one of the following studies severely altered: EEG-aEEG, US/Doppler or CSF-NSE. The first interview for W/LT happened at 25.7±28.9 hours and the mean time interval since W/LT was iniciated until death was 10.5±14 hours. Ten infants (56%) had sedation or analgesia during W/LT and presence of the family at the bedside was reported in 5 (28%).There were no changes along the ten years reviewed.

Conclusion Most deaths in infants with HIE are preceded by a clear decision of W/LT, usually within the first three days of life. The W/LT may last usually a few hours to days. We did not find changes surrounding end of life during the decade.