四级新生儿重症监护病房的终末关怀。
End of life care in a level IV outborn neonatal intensive care unit.
机构信息
Section of Neonatology, University of Chicago, Chicago, IL, USA.
Division of Palliative Care, Community Health Network, Indianapolis, IN, USA.
出版信息
J Perinatol. 2024 Jul;44(7):1022-1028. doi: 10.1038/s41372-024-01930-6. Epub 2024 Mar 14.
OBJECTIVE
Describe care surrounding the end of life (EOL) in the neonatal intensive care unit (NICU).
STUDY DESIGN
Retrospective chart review of 208 infants who died in a level IV referral-only NICU over 5 years.
RESULTS
A goals of care (GOC) conversation was documented before the day of death for 63% of infants. 73% died following withdrawal of life-sustaining treatment (WD); 13% died in a code. The median age at death was 17.5 days. 72% were held by a parent at EOL. 94% of families desired formal memory-making. We identified associations with mode of death and parental holding at death, including: WD was associated with palliative care consultation, early GOC conversations, and increased unit-specific length of stay. Holding was associated with chaplain visits, memory-making, and increased home-to-hospital distance.
CONCLUSION
We present a detailed description of EOL care in an outborn NICU, including novel data on parental holding and memory-making.
目的
描述新生儿重症监护病房（NICU）中临终关怀的情况。
研究设计
回顾性分析了 5 年内一家四级转诊 NICU 中 208 名死亡婴儿的病历。
结果
63%的婴儿在死亡前一天记录了治疗目标（GOC）谈话。73%的婴儿在停止生命支持治疗（WD）后死亡；13%的婴儿在急救中死亡。死亡时的中位年龄为 17.5 天。72%的婴儿在临终时由父母抱着。94%的家庭希望进行正式的纪念活动。我们确定了与死亡方式和父母在死亡时抱着婴儿有关的因素，包括：WD 与姑息治疗咨询、早期 GOC 谈话和单位特定住院时间延长有关。抱着婴儿与牧师探访、纪念活动和家庭到医院的距离增加有关。
结论
我们展示了一家外源性 NICU 中临终关怀护理的详细描述，包括父母抱着婴儿和进行纪念活动的新数据。
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