title: Impact of a palliative care program on end-of-life care in a neonatal intensive care unit.
abstract: OBJECTIVE
  Evaluate changes in end-of-life care following initiation of a palliative care program in a neonatal intensive care unit.
  
  
  METHODS
  Retrospective study comparing infant deaths before and after implementation of a Palliative Care Program comprised of medication guidelines, an individualized order set, a nursing care plan and staff education.
  
  
  RESULTS
  Eighty-two infants died before (Era 1) and 68 infants died after implementation of the program (Era 2). Morphine use was similar (88% vs 81%; P =0.17), whereas benzodiazepines use increased in Era 2 (26% vs 43%; P=0.03). Withdrawal of life support (73% vs 63%; P=0.17) and do-not-resuscitate orders (46% vs 53%; P=0.42) were similar. Do-not-resuscitate orders and family meetings were more frequent among Era 2 infants with activated palliative care orders (n=21) compared with infants without activated orders (n=47).
  
  
  CONCLUSIONS
  End-of-life family meetings and benzodiazepine use increased following implementation of our program, likely reflecting adherence to guidelines and improved communication.
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
authors.forename: N
authors.initials: N
authors.lastname: Younge
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
authors.forename: P B
authors.initials: PB
authors.lastname: Smith
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
authors.forename: R N
authors.initials: RN
authors.lastname: Goldberg
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
authors.forename: D H
authors.initials: DH
authors.lastname: Brandon
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
authors.forename: C
authors.initials: C
authors.lastname: Simmons
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
authors.forename: C M
authors.initials: CM
authors.lastname: Cotten
authors.affiliation: Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
authors.forename: M
authors.initials: M
authors.lastname: Bidegain
mesh_terms: D001569:Benzodiazepines / Q000627:therapeutic use*; D002423:Cause of Death; D005260:Female; D006801:Humans; D007223:Infant; D066088:Infant Death; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D008297:Male; D009020:Morphine / Q000627:therapeutic use*; D010166:Palliative Care; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013727:Terminal Care; D028761:Withholding Treatment
chemical_list: D001569:Benzodiazepines; D009020:Morphine