Survey on Neonatal End-of-Life Comfort Care Guidelines Across America.

Fecha 1/12/2017 8:19:00 | Categoría: Enfermedades y tratamientos

Haug S, Farooqi S, Wilson CG, Hopper A, Oei G, Carter B. Survey on Neonatal End-of-Life Comfort Care Guidelines Across America.J Pain Symptom Manage. 2017 Nov 9. pii: S0885-3924(17)30627-9. doi: 10.1016/j.jpainsymman.2017.10.023. [Epub ahead of print]

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Infants of age < 1 year have the highest mortality rate in pediatrics. The American Academy of Pediatrics (AAP) published guidelines for palliative care in 2013, however, significant variation persists among local protocols addressing neonatal comfort care at the end-of-life (EOL).
The purpose of this study was to evaluate current neonatal EOL comfort care practices and clinician satisfaction across America METHODS: After Institutional Review Board approval (516005), an anonymous, electronic survey was sent to members of the AAP Section on Neonatal-Perinatal Medicine. Members of the listserv include neonatologists, neonatal fellow physicians, neonatal nurses and neonatal nurse practitioners from across America (United States and Canada).
There were 346/3000 (11.5%) responses with wide geographic distribution and high levels of intensive care responding (46.1% level IV, 50.9% level III, 3.0% level II). Nearly half, (45.2%) reported their primary institution did not have neonatal comfort care guidelines. Of those reporting institutional neonatal comfort care guidelines, 19.1% do not address pain symptom management. Most guidelines also do not address gastrointestinal distress, anxiety, or secretions. Thirty-nine percent of respondents stated their institution did not address physician compassion fatigue. Overall, 91.8% of respondents felt their institution would benefit from further education/training in neonatal EOL care.
Across America, respondents confirmed significant variation and verified many institutions do not formally address neonatal EOL comfort care. Institutions with guidelines commonly appear to lack crucial areas of palliative care including patient symptom management and provider compassion fatigue. The overwhelming majority of respondents felt their institutions would benefit from further neonatal EOL care training.

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