title: End-of-life care in a regional level IV neonatal intensive care unit after implementation of a palliative care initiative.
abstract: OBJECTIVE
  We hypothesized that the implementation of a neonatal palliative care initiative will result in improved markers of end-of-life care.
  
  
  METHODS
  A retrospective and prospective chart review of neonatal intensive care unit deaths was performed for 24 months before, 16 months during and 24 months after the implementation of palliative care provider education and practice guidelines (n=106). Ancillary care, redirection of care, palliative medication usage and outcome meetings in the last 48 h of life and basic demographic data were compared between epochs. Parametric and nonparametric analysis was performed.
  
  
  RESULTS
  There was an increase in redirection of care and palliative medication usage and a decrease in variability of use of end-of-life interventions (P=0.012, 0.022 and <0.001).
  
  
  CONCLUSIONS
  The implementation of a neonatal palliative care initiative was associated with increases in palliative interventions for neonates in their final 48 h of life, suggesting that such an initiative may enhance end-of-life care.
authors.affiliation: 1] Department of Neonatology, Women and Infants Hospital, Providence, RI, USA [2] Triple Board Residency Program, Brown University and Rhode Island Hospitals, Providence, RI, USA.
authors.forename: C
authors.initials: C
authors.lastname: Samsel
authors.affiliation: 1] Department of Neonatology, Women and Infants Hospital, Providence, RI, USA [2] Warren Alpert Medical School of Brown University, Providence, RI, USA.
authors.forename: B E
authors.initials: BE
authors.lastname: Lechner
mesh_terms: D005260:Female; D006282:Health Personnel / Q000193:education*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration*; D008297:Male; D010166:Palliative Care; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011788:Quality of Life; D012189:Retrospective Studies; D013727:Terminal Care