Bereaved mothers' attitudes regarding autopsy of their stillborn baby
Background: Here we present additional information from the Safe Passage Study, where the effect of alcohol exposure during pregnancy on sudden infant death syndrome and stillbirth was investigated. Objective: To explore bereaved mothers' attitudes toward obtaining an autopsy on their stillborn baby, and the future implications of consenting or non-consenting to autopsy in retrospect. Methods: Demographic data was obtained by a questionnaire. A largely qualitative mixed-methods approach was used to meet the aims of the study, using an exploratory and descriptive research design to provide a detailed description of maternal attitudes. A semi-structured questionnaire based on information from literature and reflections on practice was administered during individual interviews. Results: We interviewed 25 women who had had a recent stillbirth. The time interval between the time of consenting to autopsy and completing this study ranged from 6 to 18 months. Most participants reported that autopsy results provided peace of mind and helped alleviate their feelings of blame. Participants who were unable to comprehend the results reported negative reactions to receiving autopsy results. The majority of participants were of the opinion that they benefited from consenting to autopsy. Conclusion: Autopsy and the disclosure of its results generally contribute positively to coping following stillbirth.
Human M;Goldstein RD;Groenewald CA;Kinney HC;Odendaal HJ
South African journal of obstetrics and gynaecology
2017
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.7196/sajog.1224" target="_blank" rel="noreferrer noopener">10.7196/sajog.1224</a>
Massive opioid resistance in an infant with a localized metastasis to the midbrain periaqueductal gray
infant; Male; Analgesics; Non-U.S. Gov't; Newborn; Dose-Response Relationship; Drug; Human; Case Report; Palliative Care; Mesencephalon; Periaqueductal Gray; Brain Neoplasms/congenital/drug therapy/pathology/secondary; Drug Resistance; Hypnotics and Sedatives/therapeutic use; Morphine/therapeutic use; Opioid/therapeutic use; Rhabdoid Tumor/congenital/drug therapy/pathology/secondary; Support
We report the case of a 4-month-old infant with terminal malignancy who had systemic metastases and a localized metastasis to the dorsal midbrain periaqueductal gray (PAG). Extraordinary doses of opioids (dose equivalent of 2680 mg morphine sulfate/h, i.v.) were required to achieve adequate analgesia. The behavior of the infant, interpreted as being representative of a response to pain, may have been an aversive reaction due to the location of the lesion in the dorsal PAG. We propose that the lesion in the PAG impaired the responsiveness of this infant to the effect of opioids. This report is to alert clinicians to the possible role of the PAG in impaired opioid responsiveness in patients with terminal malignancy, as well as the possibility that pain-like signs (e.g., tachycardia, tachypnea, vocalization, facial grimacing) may indicate an aversive reaction rather than pain in non-verbal patients.
1995
Collins J J; Berde CB; Grier HE; Nachmanoff DB; Kinney HC
Pain
1995
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/0304-3959(95)00094-9" target="_blank" rel="noreferrer">10.1016/0304-3959(95)00094-9</a>
Control of severe pain in children with terminal malignancy
Child; Female; Male; Preschool; Non-U.S. Gov't; infant; retrospective studies; Pain/drug therapy; Infusions; Human; Parenteral; Support; Adolescence; Terminal Care; Neoplasms/physiopathology; Palliative Care/methods; Analgesia/methods; Morphine/administration & dosage/therapeutic use
OBJECTIVE: To identify the characteristics of the subset of children with malignancy in whom massive opioid infusions are needed during the terminal phase. DESIGN: Retrospective review of the records of the 199 patients who died of malignancy after treatment at Children's Hospital, Boston, from March 1989 to July 1993, identifying characteristics of patients who required massive opioid infusions (operationally defined as infusion of > 3 mg/kg per hour of morphine dose equivalent) during the terminal phase. RESULTS: Twelve patients (6%) required massive opioid infusions, and eight of these patients required extraordinary measures (epidural or subarachnoid infusion and/or sedation) to achieve adequate analgesia. The duration of epidural or subarachnoid infusions in three patients ranged from 3 to 9 days, and minimal complications occurred. The duration of sedation ranged from 1 to 15 days. Maximal intravenous opioid dosing ranged from 3.8 to 518 mg/kg per hour of morphine equivalent. The maximal infusion rate (exceeding all previous published reports) occurred in an infant with an isolated metastasis in the periaqueductal gray matter, a brain-stem site linked to mediating analgesia and defense reactions. The need for massive opioid dosing in 11 of 12 patients was associated with tumor spread to the spinal nerve roots, nerve plexus, large peripheral nerve, or spinal cord compression. CONCLUSIONS: Standard dosing of opioids adequately treats most cancer pain in children; however, a significant group requires more extensive management. These problems occur more commonly among patients with solid tumors metastatic to spine and major nerves.
1995
Collins J J; Grier HE; Kinney HC; Berde CB
Journal Of Pediatrics
1995
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0022-3476(95)70370-5" target="_blank" rel="noreferrer">10.1016/s0022-3476(95)70370-5</a>