Farmer Zachary J, Palmaccio-Lawton Samantha J, Flint Hilary A, Whitford Brittney, Thienprayoon Rachel, Nee Krista
Department of Neonatology, Nationwide Children's Hospital, Columbus, OH, USA.
Department of Palliative & Hospice Medicine, Nationwide Children's Hospital, Columbus, OH, USA.
J Perinatol. 2023 Jul;43(7):889-894. doi: 10.1038/s41372-023-01664-x. Epub 2023 Apr 1.
Perinatal palliative care (PPC) is the coordinated application of palliative care principles to the care of families, fetuses and newborns with suspected life-limiting conditions. This approach relies on continuity of care that spans pregnancy, birth and beyond. The goal of this retrospective cohort study was to evaluate outcomes and PPC continuity in infants born to families who received PPC at a quaternary care pediatric hospital, and to identify targets to improve care continuity.
PPC patients seen between July 2018 and June 2021 were identified via local PPC registry. Demographic, outcome, and continuity data were gathered from the electronic medical record. Descriptive statistics were used to calculate the rate of postnatal palliative consult and infant mortality rates.
181 mother-infant dyads were identified as having a PPC consultation and had available data following birth. Overall perinatal mortality was 65%; 59.6% of all liveborn infants died prior to discharge. Only 47.6 % of liveborn infants, who did not die in the perinatal period, received postnatal palliative care. Location of birth (primary versus non-network hospital) was significantly associated with postnatal PPC consult rate (p = 0.007).
Continuation of palliative care after birth in families who received perinatal palliative care is inconsistently achieved. Creating reliable systems for PPC continuity will depend on location of care.
围产期姑息治疗（PPC）是将姑息治疗原则协调应用于对疑似患有危及生命疾病的家庭、胎儿和新生儿的护理。这种方法依赖于贯穿妊娠、分娩及之后的持续护理。这项回顾性队列研究的目的是评估在一家四级护理儿童医院接受PPC的家庭所生婴儿的结局和PPC的连续性，并确定改善护理连续性的目标。
通过当地的PPC登记处确定2018年7月至2021年6月期间就诊的PPC患者。从电子病历中收集人口统计学、结局和连续性数据。使用描述性统计来计算产后姑息咨询率和婴儿死亡率。
181对母婴被确定接受了PPC咨询，且出生后有可用数据。围产期总体死亡率为65%；所有活产婴儿中有59.6%在出院前死亡。在围产期未死亡的活产婴儿中，只有47.6%接受了产后姑息治疗。出生地点（主要医院与非网络医院）与产后PPC咨询率显著相关（p = 0.007）。
接受围产期姑息治疗的家庭在婴儿出生后继续进行姑息治疗的情况并不一致。建立可靠的PPC连续性系统将取决于护理地点。
