ABSTRACT
Birth is traditionally thought of as a wonderful experience, filled with new
hope, love, and short-term pain for long-term gain. In the world of the Neonatal
Intensive Care Unit (NICU), this perfect birth story changes, because of a
life-limiting or life-changing diagnosis that may lead to death as the final
outcome. Our Neonatal Intensive Care Unit has been in existence for more
than 50 years (1961) when a brave neonatologist (Dr. Paul Swyer, https://www.
paeds.utoronto.ca/division/neon.htm) began the daunting work of developing
and trialing ventilation with tiny newborns who were unable to breathe effectively
due to their prematurity, birth trauma, or other medical and surgical conditions.
In fact, our hospital (The Hospital for Sick Children, later called SickKids) is
considered the birthplace of Neonatology in North America, a distinction that
we are very proud of. Many of the babies cared for with this early technology
died despite medical treatment, as technology was very primitive, but there were
some survivors of these new technologies in those early years. As technology
improved and our understanding of the clinical issues and treatments improved,
so did our mortality rate. Currently, the mortality rate in this NICU is approxi-
mately 8/100 admissions, but this does not include the infants who died while
in the care of our ACTS Transport Team or those who died after transition home
for palliation (Simpson, Xiang, Hellmann, & Tomlinson, 2010).
