Background Virtually all neonatal intensive care unit (NICU) deaths are accompanied by the administration of analgetics and/or sedatives to relieve pain and suffering. Interestingly, a considerable proportion of deaths occur in the delivery room (DR), where the use of palliation at the time of death has not been well studied.

Objective To clarify the circumstances of death and dying in the DR, by describing the end-of-life decision-making and decisions regarding the provision of palliative care.

Design and Methods We reviewed the medical files of all newborns of >22 weeks who died in the DR between 1 January 2006 and 31 December 2007 in a Dutch tertiary care hospital. We abstracted information from the files to determine demographics and details about end-of-life decision-making and palliative care management.

Results In 24 months, 28 newborns died in the DR, with a median gestational age of 24 weeks. Ten newborns had severe congenital malformations, seven of these cases concerned termination of pregnancy. Of the remaining 18 extremely premature newborns, 16 were electively not resuscitated. The median time until death was 61 minutes (range 1–165 minutes). Symptoms around death were undocumented in 90% of cases. Documented symptoms were: gasping (2) and respiratory insufficiency (1). In 71% of cases, the newborn died in the parent’s arms, in the remaining cases, documentation was absent. No newborn received palliative care medication. Follow-up visits after death occurred in 77% of cases.

Conclusion The proportion of dying newborns without palliative care medication is 100%. Documentation of circumstances of dying in the DR is poor.