Schulze A, Wermuth I
Neonatologie, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Standort Grosshadern, Ludwig-Maximilians-Universität, München, Germany.
Z Geburtshilfe Neonatol. 2007 Apr;211(2):54-9. doi: 10.1055/s-2005-836629.
Involvement of the family in decisions to withhold or withdraw intensive care and parental involvement in care planning for terminally ill infants does not aggravate or prolong parents' grief responses, their feelings of guilt, or the incidence of pathological grief responses. Effective physical pain and symptom management is critically important. Compassionate care plans, however, need to implement a number of other and equally important components. Parents are not uniform in their perceived needs to make various kinds of contacts with their dying infant. They should be allowed to make their individual choices regarding contact with their baby during that time. The perinatal loss of a twin infant appears to evoke no less serious stress and risks to parents' compared to the loss of a singleton. The disruption of family life during a perinatal loss affects siblings of the baby, and their specific needs should be acknowledged. Post-death or post-autopsy meetings with the family should routinely be scheduled a few weeks after death, and bereavement support should actively be offered. Parents need to be informed about differences to be expected between maternal and paternal grief responses. The risk of pathological grief variants and chronic grief should be mentioned to parents because professional help is required in such occurrence.
让家庭参与关于放弃或撤销重症监护的决策以及让父母参与绝症婴儿的护理计划,并不会加重或延长父母的悲伤反应、他们的内疚感或病理性悲伤反应的发生率。有效的身体疼痛和症状管理至关重要。然而,富有同情心的护理计划需要实施许多其他同样重要的组成部分。父母在与濒死婴儿进行各种接触的感知需求方面并不一致。在此期间,应允许他们就与婴儿的接触做出个人选择。与单胎婴儿夭折相比,双胎婴儿的围产期夭折似乎给父母带来的压力和风险同样严重。围产期夭折期间家庭生活的中断会影响婴儿的兄弟姐妹,他们的特殊需求应得到认可。应在死亡几周后定期安排与家属的死亡后或尸检后会议,并应积极提供哀伤支持。需要告知父母母婴悲伤反应之间预期的差异。应向父母提及病理性悲伤变体和慢性悲伤的风险,因为出现这种情况需要专业帮助。