Neonates receiving end of life care in a tertiary perinatal hospital-a retrospective review

Abstract

Background:We aim to identify characteristics of neonateswho begin end of life care in a tertiary perinatal centre and to explore referral patterns of these infants to external level 6 paediatric palliative care services. This review is intended to provide information to support development of a formal perinatal palliative care service. Method: A retrospective review of a Perinatal Mortality Database (PMD) and further review of the subgroup referred to the paediatric palliative care service (PPCS). Setting: A single centre tertiary perinatal hospital and the affiliated tertiary paediatric referral hospital. Participants: (1) All infants entered into the PMD, (2) infants who had care redirected to end of life care antenatally or whilst an inpatient in the perinatal hospital and (3) all neonatal patients referred to the paediatric palliative care services over a four-year period. Results: End of life care was provided to (a) neonates born at the extremes of viability (42%), (b) those with complex congenital abnormalities (37%) and (c) those who succumbed to other perinatal conditions despite intensive medical intervention (21%). There were 35 referrals to PPCS from the perinatal centre. Infants diagnosed with life limiting conditions antenatally (n = 25, 71%) or those considering discharge or transfer prior to death (n = 24, 96%) were more likely to be referred to PPCS. Conclusions: Significant numbers of neonates receive end of life cares in the perinatal hospital. It is likely that many will benefit from the in-house presence of a structured perinatal palliative care service. Development of a core working group is recommended to complement the current combined services.L6140239932017-01-13 <br />