Clinics in Mother and Child Health

Short-term outcomes of treatment limitation discussions in neonatal care units of tertiary care hospital in Karachi, Pakistan: A cross-sectional study

3^rd International Congress on Pediatrics and Neonatology

November 18-19, 2024 | Paris, France

Rozina Muhammad Iqbal

Aga Khan University Hospital, Pakistan

Scientific Tracks Abstracts: Clinics Mother Child Health

Abstract:

Treatment Limitation Discussion (TLD) or redirection of goals of care involves shifting the focus of medical treatment from curative to symptomatic or comfort care, following a conversation between healthcare providers and parents. In low- and middle-income countries (LMIC) like Pakistan, there is limited local data on TLD practices and outcomes, underscoring the need to examine the extent of parental acceptance and the clinical impact of TLD in neonatal care. This study aimed to determine the outcomes of TLDs in infants with life-limiting conditions. It was conducted as a descriptive cross-sectional study in the neonatal care unit of a tertiary care hospital in Karachi, Pakistan, from May 2022 to May 2023. Infants with life-limiting conditions, for whom TLD was considered by clinicians or parents, were included. The primary outcomes included the frequency of full code, withdrawal of life-sustaining support, and Do Not Resuscitate (DNR) orders. The secondary outcome was the 7-day survival rate in neonates following TLD. Out of 115 patients, full code was applied to 14 (12.2%), life support was withdrawn in 54 (47.0%), and DNR orders were given in 47 (40.9%). Among these cases, 11 (9.6%) infants were discharged(DC), 90 (78.3%) died, 7 (6.1%) were transferred out of the NICU, and 7 (6.1%) left against medical advice(LAMA). Notably, 12.2% of parents opted for full code despite clinical recommendations for withdrawal or DNR, with 92.8% of these infants not surviving. Withdrawal of life-sustaining support was the most common decision post-TLD. Most infants did not survive after TLD, regardless of the chosen code, and early NICU transition was observed in cases with DNR orders.

Biography :

Dr. Rozina Muhammad Iqbal is a dedicated pediatrician with a strong foundation in pediatric care and education, currently serving as a chief resident at Aga Khan University Hospital (AKUH). She completed her MBBS from Dow Medical College and her pediatric residency at AKUH, an ACGME-I accredited institution, in December 2023. With expertise in pediatric care, clinical audits, and resident training, Dr. Iqbal is committed to advancing pediatric outcomes through evidencebased practices. Her work includes contributions to academic publications and training programs for young physicians. Dr. Iqbal’s research focuses on pediatric care in low- and middle-income settings, aiming to influence policy and clinical practices.