Carter Brian S
University of Missouri-Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA.
Children's Mercy Hospital, Kansas City, MO 64108, USA.
Children (Basel). 2018 Feb 7;5(2):21. doi: 10.3390/children5020021.
The application of palliative and hospice care to newborns in the neonatal intensive care unit (NICU) has been evident for over 30 years. This article addresses the history, current considerations, and anticipated future needs for palliative and hospice care in the NICU, and is based on recent literature review. Neonatologists have long managed the entirety of many newborns' short lives, given the relatively high mortality rates associated with prematurity and birth defects, but their ability or willingness to comprehensively address of the continuum of interdisciplinary palliative, end of life, and bereavement care has varied widely. While neonatology service capacity has grown worldwide during this time, so has attention to pediatric palliative care generally, and neonatal-perinatal palliative care specifically. Improvements have occurred in family-centered care, communication, pain assessment and management, and bereavement. There remains a need to integrate palliative care with intensive care rather than await its application solely at the terminal phase of a young infant's life-when s/he is imminently dying. Future considerations for applying neonatal palliative care include its integration into fetal diagnostic management, the developing era of genomic medicine, and expanding research into palliative care models and practices in the NICU.
在新生儿重症监护病房（NICU）为新生儿提供姑息治疗和临终关怀已有30多年的历史。本文基于近期文献综述，探讨了NICU中姑息治疗和临终关怀的历史、当前考量因素以及预期的未来需求。鉴于早产和出生缺陷相关的相对较高死亡率，新生儿科医生长期以来管理着许多新生儿短暂生命的全过程，但他们全面提供跨学科姑息治疗、临终关怀和丧亲照护连续统一体的能力或意愿差异很大。在此期间，全球新生儿科服务能力有所增长，对儿童姑息治疗的总体关注以及对新生儿 - 围产期姑息治疗的具体关注也在增加。在以家庭为中心的照护、沟通、疼痛评估与管理以及丧亲照护方面都有了改进。仍然需要将姑息治疗与重症监护相结合，而不是仅在幼儿生命的终末期（即濒临死亡时）才应用。应用新生儿姑息治疗的未来考量因素包括将其整合到胎儿诊断管理中、基因组医学的发展时代以及扩大对NICU中姑息治疗模式和实践的研究。
