The diagnosis of death by neurological criteria (DNC) in infants less than two months old

This report provides recommendations on the diagnosis of death by neurological criteria (DNC) in infants from 37 weeks corrected gestation (post menstrual) to two months (post term) of age.

Background

The RCPCH, by the request of the Academy of Medical Royal Colleges (AoMRC), has updated the report published in 1991 by the British Paediatric Association (currently RCPCH) which was titled ‘Diagnosis of Brain Stem Death in Infants and Children: A Working Party report by the British Paediatric Association’. For the update, a working group was convened to produce recommendations on the diagnosis of death by neurological criteria (DNC) in infants from 37 weeks corrected gestation (post menstrual) to two months post term.

The report presents recommendations for the diagnosis of DNC in infants following rigorous methodology to review the existing related scientific literature and provides recommendations on the diagnosis of DNC in infants from 37 weeks corrected gestation (post menstrual) to two months (post term) of age. Previous guidance has excluded infants in this age group due to the lack of evidence surrounding the presence of the required criteria in this group. However, through review of the current evidence the working group considered there was now sufficient evidence to extend the criteria for diagnosis to this group.

Full report

This report is aimed at UK paediatric and neonatal healthcare staff working with infants under two months of age. The target population for the recommendations are infants between the ages of 37 weeks corrected gestation (post menstrual) and two months post term and they are not applicable to pre term infants less than 37 weeks corrected gestation (post menstrual) age or infants older than two months post term. For infants older than two months the 2008 AoMRC ‘A Code of Practice for the Diagnosis and Confirmation of Death’ recommendations continue to apply.

Full report (PDF, 623KB, 35pages)

Methodology

This guideline has been developed in accordance with NICE accreditation, and has been produced in accordance with the RCPCH Standards for development of clinical guidelines in paediatrics and child health (2009) (PDF, 695KB, 46 pages). 

NICE accreditation logo

For full details please see the Methodology document (PDF, 257KB, 15 pages).

Project stakeholders:

  • British Association of Perinatal Medicine
  • British Medical Association
  • British Organ Donor Society
  • British Paediatric Neurology Association
  • British Transplantation Society
  • Carer Network
  • College of Emergency Medicine
  • Coroner’s Officers Association
  • Donor Family Network
  • Faculty of Pharmaceutical Medicine
  • Human Tissue Authority
  • National Patient Safety Agency
  • Neonatal Nurses Association
  • NHS Blood and Transplant
  • Nursing and Midwifery Council
  • Paediatric Intensive Care Society
  • RCPCH Ethics and the Law Advisory Committee
  • Resuscitation Council UK
  • Royal College of Anaesthetists
  • Royal College of Nursing
  • Royal College of Obstetricians and Gynaecologists
  • Royal College of Pathologists, Specialist Advisory Committee
  • Royal College of Physicians
  • Royal College of Radiologists, Patient Liaison Group
  • Scottish Intensive Care Society
  • The Royal College of Anaesthetists
  • The Royal College of Radiologists

Update

The evidence should be reviewed five years after publication, and the views of healthcare professionals, parents and carers should be sought to assess whether the guidance requires updating.

Contact

If you have any questions in relation to the development of this report, please contact clinical.standards@rcpch.ac.uk.