Fortney Christine A, Steward Deborah K
Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio (Dr Fortney); and The Ohio State University College of Nursing, Columbus (Dr Steward).
Adv Neonatal Care. 2015 Feb;15(1):48-55. doi: 10.1097/ANC.0000000000000132.
In neonates, the course of illness is often unpredictable and symptom assessment is difficult. This is even truer at the end of life (EOL). Time to death can take minutes to days, and ongoing management of the infant is needed during the time between discontinuation of life-sustaining treatment and death to ensure that the infant remains free of pain and suffering. The symptoms experienced by neonates as they die, as well as best ways to treat those symptoms, are understudied. The purpose of this study was to examine symptoms exhibited by neonates at the EOL and the treatments used to manage those symptoms as documented in the medical record during the last 24 hours of life.
The sample included 20 neonates who died at a large children's hospital.
This was an exploratory, descriptive study.
Descriptive data, such as diagnosis, ongoing therapy at time of treatment withdrawal or withholding, pharmacologic and nonpharmacologic interventions associated with treatment withdrawal, time of treatment withdrawal and death, age at time of death, signs and symptoms exhibited during EOL care, and pain scores, were abstracted from the infant's medical record.
Inadequate documentation in the medical record resulted in missing data that made it not possible to fully explore aspects of symptom management during the last 24 hours of life; however, some important results were found.
This study showed a difference in the way neonates approach the EOL period. Other findings were that most infants in the study received pain medication, even though pain scores were infrequently documented and drug dosages varied across infants. Finally, documentation of nonpharmacologic interventions utilized at the EOL was also lacking.
在新生儿中，疾病进程往往不可预测，症状评估也很困难。在生命末期（EOL）更是如此。死亡时间可能从几分钟到几天不等，在停止维持生命治疗至死亡这段时间内，需要对婴儿进行持续管理，以确保婴儿免受疼痛和痛苦。新生儿临终时所经历的症状以及治疗这些症状的最佳方法尚未得到充分研究。本研究的目的是检查新生儿在生命末期表现出的症状，以及在生命的最后24小时内病历中记录的用于管理这些症状的治疗方法。
样本包括在一家大型儿童医院死亡的20名新生儿。
这是一项探索性描述性研究。
从婴儿病历中提取描述性数据，如诊断、停止或 withholding 治疗时正在进行的治疗、与停止治疗相关的药物和非药物干预、停止治疗和死亡时间、死亡时年龄、临终护理期间表现出的体征和症状以及疼痛评分。
病历记录不充分导致数据缺失，使得无法全面探索生命最后24小时内症状管理的各个方面；然而，还是发现了一些重要结果。
本研究显示了新生儿进入生命末期的方式存在差异。其他发现包括，尽管很少记录疼痛评分且不同婴儿的药物剂量不同，但研究中的大多数婴儿都接受了止痛药物治疗。最后，生命末期使用的非药物干预措施的记录也很缺乏。
