End-of-life care for neonates and infants: The experience and effects of apalliative care consultation service

Objective. Neonates and infants have the highest death rate in the pediatri c population, yet there is a paucity of data about their end-of-life care a nd whether a palliative care service can have an impact on that care. The o bjective of this study was to describe end-of-life care for infants, includ ing analysis of palliative care consultations conducted in this population. We hypothesized that the palliative care consultations performed had an im pact on the infants' end-of-life care. Design. A retrospective chart review using the "End of Life Chart Review" f rom the Center to Improve Care for the Dying was conducted. The participant s were the patients at Children's Hospital of Wisconsin who died at <1 year of age during the 4-year period between January 1, 1994, and December 31, 1997. The patients' place of death, medical interventions performed, and em otionally supportive services provided to families were analyzed. Results. Among the 196 deaths during the study period, 25 (13%) of these in fants and families had palliative care consultations. The rate of consultat ions increased from 5% of the infant deaths in 1994 to 38% of the infant de aths in 1997. Infants of families that received consultations had fewer day s in intensive care units, blood draws, central lines, feeding tubes, vasop ressor and paralytic drug use, mechanical ventilation, cardiopulmonary resu scitation, and x-rays, and the families had more frequent referrals for cha plains and social services than families that did not have palliative care consultations. Conclusions. This study describes the end-of-life care that infants and the ir families received. Fewer medical procedures were performed, and more sup portive services were provided to infants and families that had a palliativ e care consultation. This suggests that palliative care consultation may en hance end-of-life care for newborns.