Perinatal palliative care: a dedicated care pathway

Abstract

Objective: Ensure access to perinatal palliative care (PnPC) to all eligible fetuses/infants/parents.

Design: During 12 meetings in 2016, a multidisciplinary work-group (WG) performed literature review (Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method was applied), including the ethical and legal references, in order to propose shared care pathway.

Setting: Maternal-Infant Department of Padua's University Hospital.

Patients: PnPC eligible population has been divided into three main groups: extremely preterm newborns (first group), newborns with prenatal/postnatal diagnosis of life-limiting and/or life-threatening disease and poor prognosis (second group) and newborns for whom a shift to PnPC is appropriate after the initial intensive care (third group).

Interventions: The multidisciplinary WG has shared care pathway for these three groups and defined roles and responsibilities.

Main outcome measures: Prenatal and postnatal management, symptom's treatment, end-of-life care.

Results: The best care setting and the best practice for PnPC have been defined, as well as the indications for family support, corpse management and postmortem counselling, as well suggestion for conflicts' mediation.

Conclusions: PnPC represents an emerging field within the paediatric palliative care and calls for the development of dedicated shared pathways, in order to ensure accessibility and quality of care to this specific population of newborns.

Keywords: life-limiting diseases; life-threatening diseases; neonatal mortality; neonatal pain management; paediatric palliative care; perinatal palliative care.