DNR Order Review in Pediatric Patients
DNR orders in pediatric patients must be reviewed periodically based on the patient's clinical condition and are not valid for life. 1
The Correct Next Step: Condition-Based Review
The physician must establish a system for periodic review of the DNR order, triggered by changes in the patient's clinical condition rather than following a fixed time interval. 1 The American Heart Association explicitly states that DNR orders are medical orders, not permanent directives, and must be actively maintained through physician review and documentation. 1
Key Review Triggers
The DNR order should be reviewed when: 1
- The patient's clinical condition changes significantly (e.g., improvement in neurological status, new complications, or further deterioration)
- Before any surgical or procedural intervention
- At regular intervals per institutional protocol based on clinical need (not a universal fixed timeframe like 3 months or annually)
Essential Documentation at Each Review
Each review must include: 1
- Documented discussion with family/surrogate decision-makers about current clinical status and goals of care
- Clear notation of the rationale for continuing, modifying, or revoking the DNR order
- Specific instructions about which interventions are withheld and which continue (e.g., antibiotics, oxygen, pain management may continue) 2
Why DNR Orders Are Not Permanent
The American Heart Association guidelines emphasize that DNR orders must not be assumed to be "valid for life" or permanent because: 1
- Family understanding and wishes may evolve over time as emphasized by the American Academy of Pediatrics 1
- Clinical conditions can change, potentially altering the risk-benefit calculation of resuscitation
- Ongoing communication is critical to ensure the order continues to reflect current medical status and family preferences 1
Common Pitfall to Avoid
Never treat a DNR order as a "set it and forget it" directive. 1 The most dangerous assumption is that once signed, the order remains valid indefinitely without physician oversight and family communication. This violates the fundamental principle that DNR orders are active medical orders requiring continuous clinical judgment and family engagement. 1
Answer to the Question
The answer is B: DNR is reviewed based on patient's condition. 1 This is not a fixed annual review (option C) or quarterly review (option D), but rather a dynamic process tied to clinical changes and institutional protocols. 1