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


METHODS
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.


CONCLUSIONS
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.
Catlin
Anita
A
Napa Valley College, Napa, CA 94558, USA. acatlin@napanet.net
Carter
Brian
B
D002985:Clinical Protocols; D003376:Counseling; D003469:Culture; D003697:Delphi Technique; D004645:Empathy; D005066:Euthanasia, Passive / Q000523:psychology; D005190:Family / Q000208:ethnology / Q000523:psychology; D006801:Humans; D007231:Infant, Newborn; D020407:Internet; D009359:Neonatology / Q000592:standards*; D010166:Palliative Care / Q000592:standards*; D011368:Professional-Family Relations; D012944:Social Support; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000592:standards*; D009927:Tissue and Organ Procurement; D014481:United States; D015300:Ventilator Weaning