Academic Department of Palliative Medicine, Education and Research Centre, Our Lady's Hospice & Care Services, Dublin, Ireland.
Paediatric Palliative Medicine, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
Arch Dis Child Fetal Neonatal Ed. 2018 Nov;103(6):F573-F576. doi: 10.1136/archdischild-2017-313183. Epub 2017 Nov 9.
To analyse the referral patterns of perinatal patients referred to a specialist palliative care service (SPCS), their demographics, diagnoses, duration of illness, place of death and symptom profile.
A retrospective chart review of all perinatal referrals over a 4-year period to the end of 2015.
A consultant-led paediatric SPCS at Our Lady's Children's Hospital, Crumlin, Dublin, and the Coombe Women & Infants University Hospital, Dublin.
83 perinatal referrals were received in a 4-year period. Chromosomal abnormalities accounted for 35% of diagnoses, congenital heart disease 25%, complex neurological abnormalities 11% and renal agenesis 4%. 22 referrals (26.5%) were made antenatally, with 61 (73.5%) postnatally. Of the postnatal referrals, 27 (44%) were asymptomatic on referral. An opioid medication was recommended (regularly or as required) in 46 cases. Symptom control was achieved without dose titration in 43 of these cases (93%). Of 47 deaths in this group referred postnatally, 22 of these (47%) died at home with support from community teams. Discharge home for best supportive care required complex interagency communication and cooperation.
Perinatal palliative care requires effective multidisciplinary work, whether delivered in the inpatient setting or in the community. With appropriate support, end-of-life care can be delivered in the community.
分析转至专科姑息治疗服务（SPCS）的围产期患者的转诊模式、人口统计学特征、诊断、疾病持续时间、死亡地点和症状特征。
对 2015 年底前 4 年期间所有转至儿科 SPCS 的围产期患者进行回顾性图表审查。
都柏林克里姆林圣母儿童医院和科布妇女与婴儿大学医院的顾问领导的儿科 SPCS。
在 4 年期间共收到 83 例围产期转诊。染色体异常占诊断的 35%，先天性心脏病占 25%，复杂神经异常占 11%，肾发育不全占 4%。22 例（26.5%）在产前转诊，61 例（73.5%）在产后转诊。在产后转诊中，27 例（44%）在转诊时无症状。在 46 例中建议使用阿片类药物（定期或按需）。在这些病例中，43 例（93%）无需剂量滴定即可控制症状。在这组产后死亡的 47 例中，有 22 例（47%）在家中死亡，社区团队提供支持。为提供最佳支持护理而要求出院回家需要复杂的机构间沟通与合作。
围产期姑息治疗需要有效的多学科工作，无论是在住院环境中还是在社区中提供。在适当的支持下，可以在社区中提供临终关怀。
