Supplementary Material for: Continuous Deep Sedation until Death in Neonates and Infants in Flanders: A Post-Mortem Survey

<b><i>Background:</i></b> The use of analgesics and sedatives to alleviate pain and discomfort is common in end-of-life care in neonates and infants. However, to what extent those drugs are used in that context with the specific aim of bringing the infant in a state of continuous deep sedation (CDS) is currently unknown. <b><i>Methods:</i></b> We performed a nationwide mortality follow-back survey based on all deaths under the age of 1 over a period of 16 months in Flanders, Belgium. Data on CDS were linked to sociodemographic information from death certificates. Physicians completed an anonymous questionnaire. Questions measured whether CDS preceded death, and which clinical characteristics were associated with the sedation (e.g., type of drugs used and the duration of sedation). <b><i>Results:</i></b> The response rate was 83% (229/276). In 39% of all deceased neonates and infants, death was preceded by CDS. Physicians used a combination of morphine and benzodiazepines in 53%, or morphine alone in 45% of all sedation cases in order to continuously and deeply sedate the infant. In 89% of cases, death occurred within 1 week after sedation was begun, and in 92% of cases, artificial nutrition and hydration were administered until death. In 49% of cases there was no intention to hasten death, and in 40% of cases, the possibility of hastening was taken into account. <b><i>Conclusions:</i></b> CDS precedes about 2 in 5 neonatal and infant deaths. Guidelines for CDS in this age group are non-existent and it is unclear whether the same recommendations as in the adult population apply and can be considered a good practice.

<b><i>背景：</i></b> 在新生儿与婴儿的临终关怀中，使用镇痛药与镇静剂缓解疼痛与不适是常见临床实践。然而，目前尚不明确在该场景下，以将婴儿置于持续深度镇静（continuous deep sedation, CDS）状态为特定目的使用这类药物的具体占比。<b><i>方法：</i></b> 本研究针对比利时佛兰德斯地区16个月内所有1岁以下的死亡病例，开展了一项全国性死亡回溯调查。将持续深度镇静（CDS）相关数据与死亡证明中的社会人口学信息进行关联，并由医师填写匿名问卷。问卷内容涵盖CDS是否发生于死亡之前，以及与该镇静操作相关的临床特征（例如所用药物类型、镇静持续时长等）。<b><i>结果：</i></b> 本次调查的应答率为83%（229/276）。在所有已故新生儿与婴儿中，有39%的死亡病例在死前接受过CDS。在所有镇静操作中，53%的病例联合使用了吗啡与苯二氮䓬类药物，45%的病例仅单独使用吗啡，以实现对婴儿的持续深度镇静。89%的病例在镇静开始后1周内发生死亡，92%的病例在临终前接受了人工营养与补液支持。49%的病例无加速死亡的意图，另有40%的病例考虑过加速死亡的可能性。<b><i>结论：</i></b> 约五分之二的新生儿与婴儿死亡病例在死前接受过持续深度镇静。目前尚无针对该年龄组CDS的相关指南，尚不明确是否可沿用成人人群的相关推荐并将其视为合理临床实践。