title: Neonatal end of life care in a tertiary care centre in Canada: a brief report.
abstract: OBJECTIVE
  To describe the processes followed by a neonatal team engaging parents with respect to end of life care of babies in whom long term survival was negligible or impossible; and to describe feedback from these parents after death of their child.
  
  
  METHODS
  A retrospective review was conducted of health records of neonates who had died receiving palliative care over a period of 5 years at a tertiary neonatal centre. Specific inclusion criteria were determined in advance that identified care given by a dedicated group of caregivers.
  
  
  RESULTS
  Thirty infants met eligibility criteria. After excluding one outlier an average of 4 discussions occurred with families before an end of life decision was arrived at. Switching from aggressive care to comfort care was a more common decision-making route than having palliative care from the outset. Ninety per cent of families indicated satisfaction with the decision making process at follow-up and more than half of them returned later to meet with the NICU team. Some concerns were expressed about the availability of neonatologists at weekends.
  
  
  CONCLUSIONS
  A compassionate and humane approach to the family with honesty and empathy creates a positive environment for decision-making. An available, experienced team willing to engage families repeatedly is beneficial. Initiating intensive care with subsequent palliative care is acceptable to families and caregivers.
authors.affiliation: Division of Neonatology, Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
authors.forename: Koravangattu
authors.initials: K
authors.lastname: Sankaran
authors.forename: Erin
authors.initials: E
authors.lastname: Hedin
authors.forename: Heather
authors.initials: H
authors.lastname: Hodgson-Viden
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D010166:Palliative Care; D012189:Retrospective Studies; D013727:Terminal Care; D062606:Tertiary Care Centers