title: End-of-life opioid administration on neonatal and pediatric intensive care units: nurses' attitudes and practice.
abstract: OBJECTIVE
  (1) To compare caregivers attitudes on the use of end-of-life opioid analgesia in neonatal (NICU) and pediatric (PICU) intensive care units. (2) To investigate actual opioid administration to DR (delivery room), NICU and PICU patients in various end-of-life situations.
  
  
  METHODS
  (1) Administration of an anonymous self-report questionnaire survey to nurses of 2 level III NICUs and 3 PICUs, presenting 5 hypothetical NICU and PICU patients in end-of-life situations. (2) Retrospective chart review of all deaths at the above mentioned DRs (served by NICU staff), NICUs and PICUs during the years 2008-2009.
  
  
  RESULTS
  There was no difference between NICU and PICU nurses in self-proclaimed opioid administration in dying NICU or PICU patients with signs of pain (about 80%) or distress (about 65%). 35.0% of NICU and 44.5% of PICU nurses favoured opioid administration with the implicit aim of active intentional ending of life. Shortening of life as an adverse effect of end-of-life opioid analgesia was acceptable for the majority of PICU (94.5%) and NICU (87.0%) nurses. The rate of dying infants who actually had received opioids was similar in NICUs (41/74, 55.4%) and PICUs (40/68, 58.8%). In contrast, none of the neonates (n=24) who died under primary comfort care in the DR received opioids.
  
  
  CONCLUSIONS
  End-of-life opioid administration to primary comfort care patients in the DR differs fundamentally from NICU or PICU handling of dying patients. Once patients are admitted to an intensive care unit, practice and attitudes towards end-of-life opioid administration are similar in NICUs and PICUs.
authors.affiliation: Department of Neonatology, Charité University Medical Center, Berlin, Germany. lars.garten@charite.de
authors.forename: Lars
authors.initials: L
authors.lastname: Garten
authors.forename: Steffen
authors.initials: S
authors.lastname: Daehmlow
authors.forename: Tobias
authors.initials: T
authors.lastname: Reindl
authors.forename: Anke
authors.initials: A
authors.lastname: Wendt
authors.forename: Annette
authors.initials: A
authors.lastname: Münch
authors.forename: Christoph
authors.initials: C
authors.lastname: Bührer
mesh_terms: D000698:Analgesia / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001291:Attitude of Health Personnel; D002648:Child; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data; D010371:Pediatric Nursing / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid