Sunday, November 1, 2009
Learning Objective 1: Appreciate the importance of end-of-life care in the neonatal population as well as the challenges in identifying the symptoms neonates may experience as they expire
Learning Objective 2: Discuss the findings from a recent study that explored observations of symptoms experienced by neonates at the end-of-life and the associated treatment modalities.
Advances in the management of high-risk deliveries have significantly contributed to an increase in the numbers of neonates confronting prematurity, congenital anomalies, or other syndromes who survive the initial delivery resuscitation, and are admitted to a Neonatal Intensive Care Unit (NICU). Once in the NICU, the management of these neonates is focused on stabilization and survival, however for many neonates it becomes apparent that, despite all of the tremendous technical capabilities available to manage neonatal illness, treatment becomes futile and death is inevitable. The majority of deaths in the NICU are attributed to withdrawal of treatment. Once the decision is made to withdraw or withhold treatment, the emphasis must turn to managing the end-of-life (EOL) process. Unfortunately, EOL care for neonates in the NICU has received very little attention from a research perspective. Empirical evidence is lacking that characterizes the signs and symptoms the dying neonate exhibits, along with treatment strategies that are used. Because neonates cannot speak, they provide cues which must then be identified and interpreted. The effectiveness of the cues exhibited by the neonate; the capacity of the caregiver to interpret the cues correctly; and the caregiver’s knowledge of normal neurodevelopment and pathophysiology, as well as their experience and intuition impact the recognition of symptoms. Accurate evaluation of the dying neonate can be further hindered because the neonate might exhibit few obvious cues.
The purpose of this study was to examine the end-of-life course of several neonates and the observations of physicians, nurse practitioners and staff nurses in order to characterize the physical and behavioral signs and symptoms exhibited at the end of life. Further, the study identified the treatment strategies used to manage those signs and symptoms. The results of the study will be shared.
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