Adequacy Of Palliative Care In A Single Tertiary Neonatal Unit

Title

Adequacy Of Palliative Care In A Single Tertiary Neonatal Unit

Creator

Gilmour D; Davies M; Herbert A

Identifier

DOI: 10.1111/jpc.13245_16

Publisher

Journal Of Paediatrics And Child Health

Date

2016

Subject

End Of Life Care; Palliative Care; Death; Neonatal; Perinatal Death; Infant; Parents; End Of Life Care; Child; Palliative Care; Narcotics; Hospice Care; Pediatrics

Description

Aim: End-of-life care remains within the scope of practice of all neonatal units. There is a paucity of literature regarding the evidence-base for palliative care interventions in the perinatal or neonatal population (Balaguer).

Little is published regarding neonatal end-of-life care in Australia (Wilkinson). This study aimed to characterise the end-of-life care provided in an Australian tertiary neonatal centre, where paediatric palliative care was accessible via a consultative service.

Methods: This retrospective cohort study examined indicators of quality palliative care provided to forty-six infants born within a thirty-month period from January 2012 to June 2014. Included infants were liveborn, admitted to the Royal Brisbane and Women's Hospital at some time in their life and died prior to one year of age. Infants were excluded if there was no opportunity for palliative care. Indicators of quality palliative care assessed included communication, resuscitation planning, preferred location of death, symptom management, symptom management plan, multi-disciplinary team approach, caring for carers, memory making, spiritual care and bereavement care. Interventions were characterised using descriptive statistics.

Results: The most common causes of death were congenital abnormality (37%) and complications of extreme prematurity (22%). Very high proportions of infants and families had family meetings (100%), social worker involvement (100%), memory making opportunities (100%) and discussion of autopsy (91%). Opiates were prescribed to 78% in the last day of life; most (89%) were administered intravenously. For those prescribed opiates, the median parenteral morphine daily equivalent was 290 mcg/kg/day (interquartile range = 317) in the last 24 hours of life. Antenatal resuscitation planning for fetuses with a prenatal diagnosis (9%), discussion of preferred location of death (9%), communication with general practitioners (7%) and access to specialised bereavement care (3%) were infrequently provided. Palliative care consultation was sought infrequently (n = 4; 8%), precluding formal statistical comparison with the usual neonatal care cohort. The relative number of instances where indicators of quality palliative care were met was generally greater when palliative care was consulted.

Conclusions: At the time of this study, the neonatal unit was not meeting all of the end-of-life care needs of infants and their families. Care was more comprehensive when the palliative care service was consulted.

Rights

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).

Citation List Month

November 2016 List

Citation

Gilmour D; Davies M; Herbert A, “Adequacy Of Palliative Care In A Single Tertiary Neonatal Unit,” Pediatric Palliative Care Library, accessed August 1, 2021, https://pedpalascnetlibrary.omeka.net/items/show/10628.

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