Neonatal Palliative Care Development in Portugal

Purpose: There are presently no programs for Palliative care for neonates in Portugal. Infants often receive technological life extending interventions even when they have a life limiting condition. The purpose of this study was to assess physician readiness to build an end of life protocol that they would accept and practice.

Methods: The Delphi Study is a replication of that conducted in the United States in 2002 by Catlin and Carter. Fifty seven Portuguese neonatologists completed the questions in an on line Delphi method over a year's time. There were three rounds of questions that repeated until 80% consensus was obtained. Content analysis and descriptive statistics were used for analysis.

Results: Areas of consensus were reached to create a protocol for Portugal. Physicians agreed upon the planning needed (medical education, resources and local), prenatal palliative care principles, working with parents, medical needs at the end of life, and pain and symptom management.

Conclusion: Prognostic uncertainty and ethical dilemmas make planning a palliative care program for neonates in Portugal an arduous process. This first step will improve the conditions for dying infants and their parents. More research in this area is warranted.