Creation of a neonatal end-of-life palliative care protocol

被引：190

作者：

Catlin A. ^{[1
]}

Carter B. ^{[2
]}

机构：

[1] Napa Valley College, Napa, CA

[2] Division of Neonatology, Vanderbilt University, Nashville, TN

来源：

Journal of Perinatology | 2002年 / 22卷 / 3期

关键词：

D O I：

10.1038/sj.jp.7210687

中图分类号：

学科分类号：

摘要：

Objective: To create a protocol delineating the needs of patients, families, and staff necessary to provide a pain-free, dignified, family-, and staff-supported death for newborns who cannot benefit from intensive, life-extending, technological support. Study Design: Using Internet e-mail, a Delphi study with sequential questionnaires soliciting participant response, investigator analysis, and follow-up responses from participants was conducted to build a consensus document. Institutional review was granted and respondents gave consent. Recruitment was conducted at medical, ethics, nursing, and multidisciplinary organization meetings. Synthesis of 16 palliative care/end-of-life protocols developed by regional, institutional, and parent organizations was included. Participants from 93 locations in the US and 4 abroad gave feedback to 13 questions derived from clinical experience and the literature. The data underwent four rounds of analysis with 95% retention of the 101 participants over an 18-month period. Results/Conclusion: Specific consensus-based recommendations are presented with a description of palliative care; categories of candidates; planning and education needed to begin palliative care services; relationships between community and tertiary centers; components of optimally supported neonatal death; family care, including cultural, spiritual, and practical needs; ventilator withdrawal, including pain and symptom management; recommendations when death does not occur after cessation of life-extending interventions; family follow-up care; and necessary ongoing staff support.

引用

页码：184 / 195

页数：11

共 35 条

[1]

McHaffie H.E., Et al., Withholding/withdrawing treatment from neonates: Legislation and official guidelines across Europe, J. Med. Ethics, 25, pp. 440-446, (1999)

[2]

(1998)

[3]

Maternal-fetal medicine committee, society of obstetricians and gynaecologists of Canada: Management of the woman with threatened birth of an infant of extremely low gestational age, Can. Med. Assoc. J, 151, pp. 547-553, (1994)

[4]

Position Statement - Guidelines for the Responsible Utilization of Neonatal Intensive Care, (1997)

[5]

Messenger G.G., Compassionate care and comfort guidelines, J. Perinatol, 16, pp. 65-66, (1996)

[6]

(1999)

[7]

Community recommendations for appropriate humane medical care for dying or irreversibly ill patients, (1997)

[8]

Harrison H., The principles for family-centered neonatal care, Pediatrics, 92, pp. 643-650, (1993)

[9]

Cassel C.K., Foley K.M., Principles for care of patients at the end of life: An emerging consensus among the specialties of medicine, Milbank Meml. Fund Q, (1999)

[10]

Carter B., Bhatia J., Comfort/palliative care guidelines for neonatal practice: Development and implementation in an academic medical center (Medical College of Georgia), J. Perinatol, 21, pp. 279-283, (2001)

← 1 2 3 4 →