Pierucci R L, Kirby R S, Leuthner S R
Division of Neonatology, Department of Pediatrics, Medical College of Wisconsin, Children's Hospital of Wisconsin, USA.
Pediatrics. 2001 Sep;108(3):653-60. doi: 10.1542/peds.108.3.653.
Neonates and infants have the highest death rate in the pediatric population, yet there is a paucity of data about their end-of-life care and whether a palliative care service can have an impact on that care. The objective of this study was to describe end-of-life care for infants, including analysis of palliative care consultations conducted in this population. We hypothesized that the palliative care consultations performed had an impact on the infants' end-of-life care.
A retrospective chart review using the "End of Life Chart Review" from the Center to Improve Care for the Dying was conducted. The participants 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 emotionally supportive services provided to families were analyzed.
Among the 196 deaths during the study period, 25 (13%) of these infants and families had palliative care consultations. The rate of consultations increased from 5% of the infant deaths in 1994 to 38% of the infant deaths in 1997. Infants of families that received consultations had fewer days in intensive care units, blood draws, central lines, feeding tubes, vasopressor and paralytic drug use, mechanical ventilation, cardiopulmonary resuscitation, and x-rays, and the families had more frequent referrals for chaplains and social services than families that did not have palliative care consultations.
This study describes the end-of-life care that infants and their families received. Fewer medical procedures were performed, and more supportive services were provided to infants and families that had a palliative care consultation. This suggests that palliative care consultation may enhance end-of-life care for newborns.
新生儿和婴儿在儿科人群中死亡率最高，但关于他们临终关怀的数据匮乏，且姑息治疗服务是否能对该护理产生影响尚不清楚。本研究的目的是描述婴儿的临终关怀，包括对该人群中进行的姑息治疗会诊的分析。我们假设所进行的姑息治疗会诊对婴儿的临终关怀有影响。
使用改善临终关怀中心的“临终病历回顾”进行回顾性病历审查。参与者为威斯康星儿童医院在1994年1月1日至1997年12月31日这4年期间死亡的1岁以下患者。分析了患者的死亡地点、所实施的医疗干预措施以及为家属提供的情感支持服务。
在研究期间的196例死亡病例中，25例（13%）婴儿及其家庭接受了姑息治疗会诊。会诊率从1994年婴儿死亡病例的5%上升至1997年的38%。接受会诊家庭的婴儿在重症监护病房的天数更少，抽血、中心静脉置管、喂食管、血管活性药物和麻痹药物使用、机械通气、心肺复苏及X光检查的次数也更少，并且与未接受姑息治疗会诊的家庭相比，这些家庭向牧师和社会服务机构的转诊更为频繁。
本研究描述了婴儿及其家庭接受的临终关怀。接受姑息治疗会诊的婴儿所接受的医疗程序更少，为婴儿及其家庭提供的支持服务更多。这表明姑息治疗会诊可能会改善新生儿的临终关怀。
