The Impact Of A Perinatal Palliative Care On Length Of Stay, Icu Days And Invasive Procedures
Objectives
Describe the history, epidemiology, and role of
perinatal palliative care.
Examine the impact of perinatal palliative care on
neonatal outcomes at the University of
Minnesota.
Explore the potential benefits of perinatal palliative
care for the infant, the parent, and the
healthcare system.
Original Research Background. The Perinatal Palliative
Care Program (PPCP) at the University of Minnesota
is a multidisciplinary program involving maternalfetal
medicine, neonatology, genetics and social work.
This team coordinates palliative care services for families
whose infants have prenatally diagnosed lifelimiting
conditions.
Research Objectives. The aim of this study was to
investigate the impact of perinatal palliative care
planning on care provided for infants born with a
life-limiting condition. We hypothesized that perinatal
palliative care planning would decrease length
of stay (LOS), number of neonatal intensive care
unit (NICU) days, and number of invasive
procedures.
Methods. This was a retrospective chart review of infants
with life-limiting conditions treated from 1/01/
11-9/30/14. Infants were identified through PPCP records
and NICU death records. Descriptive statistics
were used to describe the patient populations, continuous
data was analyzed using the Mann-Whitney U
test, and categorical data were analyzed with Fischer’s
exact test.
Results. Twenty-seven infants were identified, 18 in
the PPCP cohort and 9 in the No PPCP cohort. Infants
with an active palliative care plan at birth had a statistically
significant decrease in number of NICU days
(p¼0.001), invasive procedures performed
(p¼0.0008), CPR (p¼0.002) and resuscitation medication
administration (p¼0.008).
Conclusion. Perinatal palliative care is a relatively
recent concept in the field of palliative care medicine.
This study provides novel data that a perinatal palliative
care program can alter interaction with the healthcare
system after birth for newborns with life-limiting
conditions.
Implications for Research, Policy, and
Practice. Given the alteration in interaction with
the medical system after birth, perinatal palliative
care planning may lead to a decreased stress burden
on families, caregivers and the infant. Additionally,
perinatal palliative care planning may decrease cost
of care for these infants. Future research involving
families and caregivers would be informative.
N
Kamrath H; Needle J; Osterholm E; Stover-Haney R
Journal Of Pain And Symptom Management
2016
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).
DOI: http://dx.doi.org/10.1016/j.jpainsymman.2015.12.201
Lasting Legacy: Maternal Perspectives of Perinatal Palliative Care
Female; Fetal mortality; hospice; Infant; mothers; Newborn; palliative care; perinatal; Perinatal Care organization & administration; prenatal; Prenatal Diagnosis; Retrospective Studies
BACKGROUND: Many of the leading causes of infant mortality are diagnosed prenatally, presenting providers with the ability to present perinatal palliative care planning as an option. OBJECTIVE: Our study adds to the literature both by describing infant interaction with the health care system and by gaining deeper understanding of the maternal experience after being offered perinatal palliative care. METHODS: The study was conducted at a public university-based medical center in the Midwest. Phase 1 consisted of a retrospective review of electronic medical records of 27 mother-infant pairs offered perinatal palliative care, 18 of whom elected to develop a perinatal palliative care. Phase 2 consisted of a focus group and interviews of seven of the mothers. RESULTS: In the initial phase of this study, results revealed differences regarding the infant's end-of-life trajectory, including location of death, number of invasive procedures, and death in the setting of withholding versus withdrawing life-sustaining treatment. Highlighting that without a perinatal palliative care plan in place, the default treatment for infants with prenatally diagnosed life-limiting conditions is likely to be invasive and painful with often times minimal likelihood of long-term survival. Analysis of interview and focus group data revealed three themes: care, choice, and legacy. CONCLUSION: The authors used their experience with the health care system to draw implications for practice from the focus group and interview data, which care can serve to promote women feeling cared for and cared about, as well as promote opportunities for hope during a fragile pregnancy.
Kamrath HJ; Osterholm E; Stover-Haney R; George T; O'Connor-Von S; Needle J
Journal of Palliative Medicine
2019
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/10.1089/jpm.2018.0303" target="_blank" rel="noreferrer noopener">10.1089/jpm.2018.0303</a>