End-of-life decisions for fragile neonates: navigating between opinion and evidence-based medicine
| Autor: | Keith J. Barrington, Barbara Farlow, Eduard Verhagen, Annie Janvier |
|---|---|
| Přispěvatelé: | Health Psychology Research (HPR) |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Palliative care Decision Making Psychological intervention Patient perspective 03 medical and health sciences 0302 clinical medicine Professional-Family Relations 030225 pediatrics medicine Humans 030212 general & internal medicine Neonatology Mortality Intensive care medicine Ethics Terminal Care Evidence-Based Medicine EXTREMELY PRETERM INFANTS business.industry Palliative Care Infant Newborn Obstetrics and Gynecology Gestational age General Medicine Evidence-based medicine Pediatrics Perinatology and Child Health Cohort Neonatal death business Healthcare providers |
| Zdroj: | ARCHIVES OF DISEASE IN CHILDHOOD-FETAL AND NEONATAL EDITION, 102(2), F96-F97. BMJ PUBLISHING GROUP |
| ISSN: | 1359-2998 |
| Popis: | The majority of neonatal deaths occur after a decision to limit life-sustaining interventions (LSIs).1 Decisions on when to withhold/withdraw LSIs in fragile neonates are among the most difficult decisions in paediatric practice. Two rigorous investigations shed some light on this topic. Durrmeyer et al 2 systematically described the management of 73 delivery room deaths in the EPIPAGE-2 cohort. The vast majority of neonates had LSI withheld, at a median gestational age of 24 weeks. Pain was usually assessed: 50% of infants received comfort medication, the administration of which was not associated with the evaluation of pain but rather with the presence of gasping. Satisfaction of healthcare providers was strongly associated with the occurrence of parent-child contact, which frequently occurred. Aladangady et al 3 describe the short-term outcome of LSI-limitation discussions with parents in a prospective multicentre trial in the UK (the WILST study). Half of the parents did not agree with providers and opted to continue LSI. When this occurred, it was not rare for the neonates to survive. When parents and providers agreed that LSI should be limited, neonates rarely survived. When examining these issues, three important questions should be considered: 1. When should limitations of LSI be considered? 2. How can we optimise communication with parents?4 3. How should we care for dying neonates and their families? Fragile neonates can be grouped into three decision-making ‘zones’: (1) ‘Beneficial’, where LSIs are indicated because of good outcomes; … |
| Databáze: | OpenAIRE |
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