Adequacy of palliative care in a single tertiary neonatal unit

Gilmour, Deborah, Davies, Mark W. and Herbert, Anthony R. (2017) Adequacy of palliative care in a single tertiary neonatal unit. Journal of Paediatrics and Child Health, 53 2: 136-144. doi:10.1111/jpc.13353

Author Gilmour, Deborah
Davies, Mark W.
Herbert, Anthony R.
Title Adequacy of palliative care in a single tertiary neonatal unit
Journal name Journal of Paediatrics and Child Health   Check publisher's open access policy
ISSN 1440-1754
Publication date 2017-02-01
Year available 2016
Sub-type Article (original research)
DOI 10.1111/jpc.13353
Open Access Status Not yet assessed
Volume 53
Issue 2
Start page 136
End page 144
Total pages 9
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell Publishing
Collection year 2018
Language eng
Formatted abstract
Aim: End-of-life care remains part of the scope of practice in all neonatal units. 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 46 infants born within a 30-month period. The cohort included four infants who received palliative care consultations additional to usual neonatal care. The care provided was 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 76% 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 h of life. Antenatal resuscitation planning for families of a fetus with a prenatal diagnosis (9%), discussion of preferred location of death (9%), verbal communication with general practitioners (15%) and access to specialised bereavement care (3%) were infrequently provided.

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 generally more comprehensive when the palliative care service was consulted.
Keyword Death
End of life care
Palliative care
Perinatal care
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
School of Medicine Publications
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Created: Mon, 20 Mar 2017, 20:33:00 EST by Anthony Herbert on behalf of Children's Health Queensland Clinical Unit